• A C Schwarzer, R Derby, C N Aprill, J Fortin, G Kine, and N Bogduk.
• Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia.
• Clin J Pain. 1994 Dec 1;10(4):309-13.

ObjectiveTo determine the relationship between pain provocation and the analgesic response in lumbar zygapophyseal joint blocks.DesignConsecutive patients undergoing intraarticular zygapophyseal joint blocks for the investigation of low back pain were included in this prospective study.SettingThe referred sample was from the metropolitan areas of New Orleans and San Francisco.PatientsNinety patients with low back pain of > 3 months' duration and no history of lumbar surgery.InterventionsAll patients underwent one or more intraarticular injections of radiographic contrast followed by lignocaine (lidocaine) 2% into zygapophyseal joints between L2-3 and L5-S1. Those with definite responses at one or more levels underwent confirmatory blocks using 0.5% bupivacaine.Outcome MeasuresProvocation of familiar pain and relief of pain after the injection of local anesthetic. Patients were assessed by an independent observer.ResultsA total of 203 joints were studied. Adopting liberal criteria, either exact or similar reproduction of pain on the one hand correlated with either definite or complete relief of pain after a single, analgesic block on the other (p < 0.0001). However, when more stringent criteria were adopted, such as response to a confirmatory block using bupivacaine, there was no significant association.ConclusionsThis study calls into question the validity of pain provocation alone as a criterion standard in patients undergoing diagnostic lumbar zygapophyseal joint blocks.

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