gms | German Medical Science

Objectives: To determine the efficacy of cervical facet medial branch block with rupivacaine and cortisone, combined with duloxetine administrated orally, in treating chronic neck pain.

Methods: This randomized double blind trial included 58 patients (37 females and 21 males, mean age 48±3.8ys) suffering from cervical facet joint pain, for more than 2 (3.2±1.6) years. All patients were randomly assigned to receive either facet medial branch block with rupivacaine plus cortisone combined with duloxetine 60mg/day administrated orally for 8 weeks (Group 1), or facet medial branch alone (Group 2). Clinical outcomes were measured with VAS pain scale and Neck Disability Index score at baseline, 6 months, 1and 2 years. All patients underwent MRI of cervical spine to establish facet joint arthritis and to exclude other lesions. Each patient received totally 5 injections (1/10 days). Statistical analysis was performed by statistical packet STATA 8.0 and significance was set at p-value <0.05.

Results and Conclusion: The VAS pain score decreased significantly from 8.3/10 to 2.7/10 in Group 1 (p<0.05) and from 8.2/10 to 5.1/10 in Group 2 (p<0.05) at 2 years follow up. Neck Disability Index decreased also significantly from average 31.2/50 to 10.4/50 in Group 1 (p<0.05) and from 30.8/50 to 19.5/50 in Group 2 (p<0.05) at 2 years follow up. Significant statistical difference was detected among the two groups, regarding the VAS pain score (p=0.038, 95%CI:0.8-3.4) and the Neck Disability Index (p=0.041, 95%CI:0.1-2.8) showing superior clinical results in Group 1.

Cervical facet joint nerve blocks, with rupivacaine and cortisone combine with orally administrated duloxetine, provide long term efficient pain relief in patients suffering from cervical facet pain.