Abstract | BACKGROUND: OBJECTIVES: We hypothesized that the cervical plexus may have a role in the pathogenesis of WAD and blocking the cervical plexus may provide analgesia. STUDY DESIGN: Prospective observational trial. SETTING: Tertiary pain medicine unit at a university teaching hospital. METHODS: Adult patients who presented with refractory chronic neck pain following whiplash were included in a prospective observational trial. The pragmatic trial studied the effectiveness of 2 sequential cervical plexus blocks (iCPB with local anesthetic [iCPB-LA] and iCPB with steroid and LA mixture [iCPB- Steroid]) in refractory chronic neck pain following whiplash. Patients who reported < 50% relief at 12 weeks after iCPB-LA were offered iCPB- Steroid. Primary outcome was " neck pain at its worst in the last 24 hours" at 12 weeks. Secondary outcomes included change in neck disability index, employment status, and mood. RESULTS: After excluding cervical zygapophyseal joint dysfunction, 50 patients underwent the iCPB-LA between June 2020 and August 2022. Five patients reported > 50% relief (durable relief) at 12 weeks and 3 patients were lost to follow-up. Forty-two patients received iCPB- Steroid. iCPB- Steroid was associated with significant reduction in neck pain, neck disability, and improvement in mood at 12 weeks when compared to the block with LA. In addition, iCPB- Steroid was associated with significant reduction in neck pain and disability at 24 weeks. Due to functional improvement, 34 patients (34/50, 78%) were able to maintain employment. LIMITATIONS: This is an open-label, observational, single-center study in a limited cohort under a single physician. Cervical facet joint dysfunction was ruled out clinically and radiologically. CONCLUSIONS: Cervical plexus may play a central role in the pathogenesis of WAD. iCPB could potentially be a treatment option in this cohort.
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Authors | Arul James, Hayun Lee, Shruti Niraj, Yuvraj Kukreja, Manish Mittal, G Niraj |
Journal | Pain physician
(Pain Physician)
Vol. 26
Issue 4
Pg. E375-E382
(07 2023)
ISSN: 2150-1149 [Electronic] United States |
PMID | 37535784
(Publication Type: Observational Study, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Adult
- Humans
- Cervical Plexus Block
- Neck Pain
(complications)
- Anesthetics, Local
(therapeutic use)
- Whiplash Injuries
(complications)
- Spinal Nerves
- Chronic Pain
(etiology)
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