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Anesthesiology Research and Practice
Volume 2012, Article ID 585806, 10 pages
Clinical Study

The Role of Thoracic Medial Branch Blocks in Managing Chronic Mid and Upper Back Pain: A Randomized, Double-Blind, Active-Control Trial with a 2-Year Followup

1Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA
2EMP, Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40202, USA
3Spine Pain Diagnostics Associates, Niagara, WI 54151, USA
4Mid Atlantic Spine and Pain Physicians of Newark, DE 19702, USA
5Department of Physical Medicine and Rehabilitation, School of Medical, Temple University, Philadelphia, PA 19140, USA
6Psychological Services, Pain Management Center of Paducah, Paducah, KY 42003, USA

Received 12 March 2012; Accepted 27 May 2012

Academic Editor: Sukdeb Datta

Copyright © 2012 Laxmaiah Manchikanti et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Study Design. A randomized, double-blind, active-control trial. Objective. To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain. Summary of Background Data. The prevalence of thoracic facet joint pain has been established as 34% to 42%. Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks, radiofrequency neurotomy, and intraarticular injections. Methods. This randomized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results. Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup. Conclusions. Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin.