Cervical Facet Joint Syndrome, Cervical Facetogenic Pain, Chronic Neck Pain
Conditions
Brief summary
This prospective randomized controlled study aims to compare the analgesic effectiveness of ultrasound-guided cervical medial branch block and ipsilateral cervical erector spinae plane block in patients with cervical facetogenic pain. Patients with chronic cervical facet-mediated pain will be randomized into two intervention groups. Pain intensity, functional status, meaningful pain response rates, analgesic consumption, and patient satisfaction will be evaluated during follow-up. The primary objective is to determine whether cervical erector spinae plane block provides comparable short-term pain relief to cervical medial branch block.
Detailed description
Cervical facet joints are an important source of chronic axial neck pain. Diagnostic cervical medial branch block is commonly used to identify facet-mediated pain and may also provide short-term analgesic benefit. However, this procedure requires precise targeting of the cervical medial branches and may be technically demanding in some patients. The cervical erector spinae plane block is an ultrasound-guided interfascial plane block that may provide analgesia through cranio-caudal spread of local anesthetic along the paraspinal fascial plane. Although it has been increasingly used for perioperative and chronic pain indications, its role in cervical facetogenic pain has not been clearly established. This study will compare the short-term analgesic effectiveness of ultrasound-guided cervical medial branch block and ipsilateral cervical erector spinae plane block in patients with clinically suspected cervical facetogenic pain. Eligible patients will be randomized to receive one of the two ultrasound-guided interventions. Pain intensity, functional disability, meaningful pain response, analgesic use, patient satisfaction, and procedure-related adverse events will be assessed during follow-up. The study is designed to determine whether cervical erector spinae plane block can provide clinically meaningful pain relief comparable to cervical medial branch block in this patient population.
Interventions
OTHERUltrasound-guided cervical medial branch block
Ultrasound-guided cervical medial branch block performed at clinically suspected symptomatic cervical facet levels using local anesthetic for diagnostic and analgesic purposes.
OTHERUltrasound-guided cervical erector spinae plane block
Ultrasound-guided ipsilateral cervical erector spinae plane block performed at the symptomatic cervical level using local anesthetic for analgesic purposes.
Sponsors
Ankara City Hospital Bilkent
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants will be blinded to treatment allocation. Due to the technical and procedural differences between the interventions, the physician performing the procedure cannot be blinded.
Intervention model description
Participants with clinically suspected cervical facetogenic pain will be randomly assigned in a parallel-group design to receive either ultrasound-guided cervical medial branch block or ultrasound-guided ipsilateral cervical erector spinae plane block. Outcomes including pain intensity, meaningful pain response, functional status, analgesic consumption, and patient satisfaction will be compared between the two intervention groups during follow-up.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 80 years * Chronic neck pain lasting at least 3 months * Clinical findings suggestive of cervical facetogenic pain * Numeric Rating Scale pain score ≥4 * Ability to provide informed consent
Exclusion criteria
* Cervical radiculopathy or myelopathy * Major neurological deficit * Infection at the injection site * Coagulopathy or anticoagulant therapy contraindicating intervention * Allergy to local anesthetics * Pregnancy * Previous cervical interventional pain procedure within the last 3 months * Severe psychiatric disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Meaningful Pain Response | Time Frame: 1 hour after the procedure | Proportion of patients achieving at least 50% reduction in Numeric Rating Scale (NRS) pain score during the early post-procedural period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NRS24 | at 24 Hours | Change in pain intensity measured using the 11-point Numeric Rating Scale (0=no pain, 10=worst imaginable pain). |
| NRS1 | 1 week after the procedure | Change in pain intensity measured using the 11-point Numeric Rating Scale.( 0=no pain, 10=worst imaginable pain) |
| NDI | Baseline and 1 week after the procedure | Functional disability associated with neck pain assessed using the Neck Disability Index.0 = no disability 50 = complete disability Higher scores indicate greater neck-related functional disability (worse outcome). |
| GPE | 1 week after the procedure | Patient-reported global improvement evaluated using a 7-point Global Perceived Effect scale. The GPE scale ranges from -5 to +5, where: -5 = vastly worse 0 = no change +5 = completely recovered |
| Analgesic Consumption | 24 hours and 1 week after the procedure | Need for rescue analgesic medication after the procedure. |
| Patient Satisfaction | 1 week after the procedure | Patient satisfaction regarding the procedure. |
| Complications | Perioperative/Periprocedural | Procedure-related adverse events and complications. |
Countries
Turkey (Türkiye)
Contacts
CONTACTÜlkü Sabuncu, Assoc prof
Outcome results
None listed