Pain Societies Updated Their Guidelines For Managing Cervical Spine Joint Pain

December 28, 2022

Summary: All pain societies in the US have recently updated their guidelines for managing cervical spine joint pain. They have made similar recommendations to end the confusion and standardize treatment for the condition. The new guidelines recommend that all patients with cervical spine joint pain undergo radiological examination. Unlike older recommendations saying that RF ablation may be considered if two nerve blocks provided more than 80% pain relief. The new guidelines state that a single nerve block providing more significant than 50% pain relief is sufficient for considering RF nerve ablation.

Cervical spine joint pain or chronic neck pain is quite common. Moreover, it propagates, causing shoulder pain and even headache. Managing such pains requires prolonged use of medication and even the use of surgical interventions. Unlike medications, surgical interventions may pose a greater health threat. However, such invasive interventions may also provide permanent pain relief in many instances. Thus, one may be able to live without medications.

However, there is another important and minimally invasive procedure that is less risky and may still provide permanent pain relief, like surgical interventions. This method is called radiofrequency (RF) ablation of the cervical medial branch. Simply speaking, in the procedure, doctors use radio waves to inactivate the nerve, prevent pain propagation and thus prolong relief.

Though RF ablation may sound good due to its safety and efficacy, not everyone may benefit from this procedure. Though there have been many guidelines regarding when to use RF ablation in patients presenting with cervical pain, all pain societies in the US recently updated their guidelines simultaneously. This will help end the confusion and ensure that all pain specialists use a similar kind of treatment approach for the condition1,2.

When using RF to disable the nerve permanently, doctors use certain methods to ensure that they are selecting the right nerve and that disabling that nerve will help the patient. Thus, before RF ablation, they would carry out nerve block or facet block using medications. This procedure is reversible. Hence, if a nerve block worked for a patient and helped reduce pain, it means that such a patient can be considered for RF nerve ablation, resulting in permanent disabling of the nerve and, thus, pain relief. This entire procedure of Facet Joint Radiofrequency has shown some promising results in managing spine joint pain.

These standardized guidelines made multiple changes to ensure patient safety and improve cervical spine joint pain treatment. For many doctors, it may be a surprise that the new guideline recommends radiological imaging before considering facet block. The guidelines say that such an assessment does not play many roles in diagnosing the condition and in its prognosis. However, radiological assessment is good for safety and procedural planning.

Another exciting and significant recommendation is regarding the number of nerve blocks to carry out before going for RF nerve ablation. Early recommendations were that doctors carry out at least two nerve blocks, which must provide 80% or more pain relief. Only then may a patient be considered for RF nerve ablation.

However, now these recommendations have been changed significantly. The new recommendations say that just a single nerve block providing pain relief greater than 50% is enough to move forward with RF nerve ablation. This recommendation is significant, as doctors think that in cervical pain the facet joint is a more significant pain generator. It means that those living with cervical spinal pain are more likely to benefit from Facet Joint Radiofrequency.

Facet joint injection is a similar kind of early intervention that can help reduce opioid dependency, as many of those living with chronic cervical pain need to use these medications. Experts say that they have made these recommendations since their findings show that RF nerve ablation has better outcomes for cervical spine joint pain compared to lumbar pain or low back pain.

These guidelines would have many implications. First, it would help standardize cervical spine joint pain and sciatica nerve pain treatment. Earlier, there were multiple guidelines with different recommendations. Since now all guidelines make similar kinds of recommendations for treating the condition, it would help reduce confusion, which is good for patients. Of course, it is worth knowing that the final decision is always made by treating doctors, as they are in the best position to decide if any procedure will work for a given patient.

The standardization of guidelines would have other benefits for patients, like they are now more likely to be covered by insurance since all guidelines have similar kinds of recommendations. But, of course, these guidelines are not constant, and they may change in the future as medicine is always progressing.

The Bottom Line

Padda Institute of Pain Management has a proven record of spine joint pain and sciatica nerve pain treatment with its uniquely created facet joint radiofrequency treatment. Get in touch with our specialists to get pain relief.

By Gurpreet Singh Padda, MD, MBA, MHP