Pain practice : the official journal of World Institute of Pain
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Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques. ⋯ Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.
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In this study, the spread of methylene blue was compared between an ultrasound-guided Pericapsular Nerve Group (PENG) block and a double injection technique, where the approach towards the inferomedial acetabulum was added to the latter. ⋯ Our study demonstrates adequate staining of the iliac bone with comparable distal and medial spread in both techniques, indicating that the PENG block with a single injection is adequate in blocking the hip capsule with 10 mL local anesthetics. Staining of the femoral nerve occurred in 2/6 specimens after the PENG block, and staining of the obturator nerve in 1 specimen in each group.
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Chronic pain is a debilitating, multifactorial condition. The purpose of this study was to examine patient characteristics of those who did not show up for their scheduled first pain medicine appointment in order to identify factors that may improve access to care. ⋯ High no-show rates were present particularly among younger patients. Having a referral from another specialty was an independent predictor of lower no-show rates.