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Blocks for Chronic Pain: Facet and Nerve
Jad S. Husseini, MD
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KEY FACTS

  • Terminology

    • Basic Principles

      • Post Procedure

        • Outcomes

          Basic Approach

          • Identify Source of Pain

            • Select Appropriate Imaging Modality

              • Administer Injectate Consisting of Anesthetic and Corticosteroid as Close to Target Structure as Possible

                Imaging Modalities

                • Key Concepts

                  • Imaging Approaches

                    Medications for Chronic Pain Procedures

                    • Local Anesthetic

                      • Injectate

                        • Contrast Medium for Fluoroscopic and CT-Guided Procedures

                          Selected References

                          1. Al-Najjim M et al: Lumbar facet joint injection in treating low back pain: radiofrequency denervation versus SHAM procedure. Systematic review. J Orthop. 15(1):1-8, 2018
                          2. Manchikanti L et al: Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain. 31(1):27-38, 2018
                          3. Nwawka OK et al: Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. 207(3):507-16, 2016
                          4. Palmer WE: Spinal injections for pain management. Radiology. 281(3):669-88, 2016
                          5. Hong JP et al: Ultrasound-guided injection for the treatment of carpal tunnel syndrome. Am J Phys Med Rehabil. 94(12):e119-20, 2015
                          6. Peh W: Image-guided facet joint injection. Biomed Imaging Interv J. 7(1):e4, 2011
                          7. Tagliafico A et al: Peripheral nerves: ultrasound-guided interventional procedures. Semin Musculoskelet Radiol. 14(5):559-66, 2010
                          8. Takahashi Y et al: Dorsoventral organization of sensory nerves in the lumbar spine as indicated by double labeling of dorsal root ganglion neurons. J Orthop Sci. 15(4):578-83, 2010
                          9. Manchikanti L et al: Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 10(3):425-40, 2007
                          10. Sehgal N et al: Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Physician. 10(1):213-28, 2007
                          11. Gorbach C et al: Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol. 186(5):1228-33, 2006
                          12. Silbergleit R et al: Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics. 21(4):927-39; discussion 940-2, 2001
                          Related Anatomy
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                          Related Differential Diagnoses
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                          References
                          Tables

                          Tables

                          KEY FACTS

                          • Terminology

                            • Basic Principles

                              • Post Procedure

                                • Outcomes

                                  Basic Approach

                                  • Identify Source of Pain

                                    • Select Appropriate Imaging Modality

                                      • Administer Injectate Consisting of Anesthetic and Corticosteroid as Close to Target Structure as Possible

                                        Imaging Modalities

                                        • Key Concepts

                                          • Imaging Approaches

                                            Medications for Chronic Pain Procedures

                                            • Local Anesthetic

                                              • Injectate

                                                • Contrast Medium for Fluoroscopic and CT-Guided Procedures

                                                  Selected References

                                                  1. Al-Najjim M et al: Lumbar facet joint injection in treating low back pain: radiofrequency denervation versus SHAM procedure. Systematic review. J Orthop. 15(1):1-8, 2018
                                                  2. Manchikanti L et al: Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial. Korean J Pain. 31(1):27-38, 2018
                                                  3. Nwawka OK et al: Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. 207(3):507-16, 2016
                                                  4. Palmer WE: Spinal injections for pain management. Radiology. 281(3):669-88, 2016
                                                  5. Hong JP et al: Ultrasound-guided injection for the treatment of carpal tunnel syndrome. Am J Phys Med Rehabil. 94(12):e119-20, 2015
                                                  6. Peh W: Image-guided facet joint injection. Biomed Imaging Interv J. 7(1):e4, 2011
                                                  7. Tagliafico A et al: Peripheral nerves: ultrasound-guided interventional procedures. Semin Musculoskelet Radiol. 14(5):559-66, 2010
                                                  8. Takahashi Y et al: Dorsoventral organization of sensory nerves in the lumbar spine as indicated by double labeling of dorsal root ganglion neurons. J Orthop Sci. 15(4):578-83, 2010
                                                  9. Manchikanti L et al: Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Pain Physician. 10(3):425-40, 2007
                                                  10. Sehgal N et al: Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Physician. 10(1):213-28, 2007
                                                  11. Gorbach C et al: Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol. 186(5):1228-33, 2006
                                                  12. Silbergleit R et al: Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics. 21(4):927-39; discussion 940-2, 2001