• Laxmaiah Manchikanti, Vijay Singh, Frank J E Falco, Kimberly A Cash, Vidyasagar Pampati, and Bert Fellows.
• Pain Management Center of Paducah, Paducah, KY, USA. drlm@thepainmd.com
• Pain Physician. 2010 Nov 1;13(6):535-48.

BackgroundThoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34% to 42% of patients when the modified criteria of the International Association for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch blocks, and radiofrequency neurotomy of thoracic medial branch nerves.Study DesignA randomized, double-blind, active controlled trial.SettingA private practice, interventional pain management setting, and a specialty referral center setting in the United States.ObjectiveTo determine the clinical effectiveness of therapeutic local anesthetic medial branch blocks with or without steroid in managing chronic function-limiting mid back or upper back pain of facet joint origin.MethodsThe study was performed in an interventional pain management private practice, a tertiary referral center, in the United States. A total of 100 participants were included, with 50 participants in each of the local anesthetic and steroid groups. All of the participants met the diagnostic criteria of thoracic facet joint pain by means of comparative, controlled diagnostic blocks and the inclusion criteria. Group I participants received thoracic medial branch blocks with bupivacaine, whereas Group II participants received thoracic medial branch blocks with bupivacaine and non-particulate betamethasone.Outcomes AssessmentOutcomes measures included numeric rating scores (NRS), Oswestry Disability Index (ODI), opioid intake, and return to work status at baseline, 3 months, 6 months, and 12 months. Significant pain relief was defined as >/= 50% pain relief and/or a positive change in ODI scores.ResultsIn Group I and Group II 90% of participants showed significant pain relief and functional improvement at 12 months. The majority of the participants experienced significant pain relief of 47.2 ± 10.1 weeks in Group I and 46.3 ± 8.4 weeks in Group II, requiring approximately 3.5 treatments per year with an average relief of 15.8 ± 10.5 in Group I and 13.6 ± 3.6 weeks in Group II per episode of treatment.LimitationsStudy limitations include the lack of a placebo group.ConclusionsTherapeutic thoracic medial branch blocks, with or without steroid, may provide a management option for chronic function-limiting mid back or upper back pain of facet joint origin.Clinical TrialNCT00355706.

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