22 Oct 2013

Radiofrequency Treatment for Chronic Neck Pain

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Neck pain is the second most common reason that patients come to my office to address (#1 is back pain).  Although there are many causes of neck pain, one of the most common is diagnosis that is often missed.  The good news is that an excellent treatment is available!

Cervical Facet Pain

I have written previously about the problem of facet problems in the low back.  Facet joints are joints that connect each level of the spine, from the top of the neck to the sacrum at the base of the spine.  In the neck, it is common for these joints to become irritated, either by trauma (whiplash is common) or by chronic degeneration (like arthritis).  Pain from these joints is typically felt in the neck, often worse on one side than the other.  Depending on the facet joint, it can also radiate to the head, shoulders, shoulder blades, or upper back.

How common is cervical facet pain?  One estimate is that 40 to 60% of neck pain that does not radiate to the arms is caused by facet problems.

Making the Neck Pain Diagnosis

The main reason why such a common cause of neck pain gets missed, or dismissed as “nonspecific” neck pain, is that it is hard to examine these joints with a physical examination or even advanced imaging like MRI.  Besides tenderness in the neck near the facet joints, there are no good maneuvers that single out facet joints as the generator of one’s neck pain.

The gold standard for diagnosis is a procedure called cervical medial branch block.  It is a simple procedure that takes only a few minutes.  The idea is to use a tiny amount of local anesthetic to temporarily block sensation from a few facet joints in the neck without numbing anything else.  If pain is coming from facet joints, there should be a substantial (but usually temporary) decrease in pain.  Then we have our diagnosis.  If there is no change, we know to look for a different pain source.

Radiofrequency Treatment of Neck Facet Pain

In 1996, The New England Journal of Medicine published a landmark study in the area of chronic neck pain.  Lord and colleagues studied patients who had a history of chronic neck pain after motor vehicle accidents with whiplash.  Among that group of patients, many were diagnosed with facet joint pain, using the medial branch block test described above.  They were then randomized to receive either radiofrequency treatment or a fake placebo treatment.  Because the treatment uses local anesthetic to numb the neck before treatment, patients were not able to tell if they had received the true treatment, or placebo.  Nevertheless, those who received the radiofrequency had a significant improvement in pain.  On average, the average participant went for 9 months before their pain returned to even half the level it had been at before the procedure.

Today, radiofrequency neurotomy has become a very popular treatment for such neck pain.  It is safe, quick, and greatly relieves neck pain and radiating headaches from the neck without surgery or medications.  It is one of the best treatments that I am able to offer my patients.

 

Neck image by Anatomography [CC-BY-SA-2.1-jp], via Wikimedia Commons
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About Leo Lombardo, M.D.

Leo Lombardo, M.D. is a dual-board-certified pain physician and founder of Ventura Pain and Spine Physicians, a medical practice serving Ventura, Oxnard, Camarillo, and all of Ventura County.

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