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Review
. 2020 Oct 29;17(21):7932.
doi: 10.3390/ijerph17217932.

Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

Gordon E Lawson  1 , Paul S Nolet  2 , Adam R Little  3 , Anit Bhattacharyya  4 , Vivian Wang  1 , C Adam Lawson  5 , Gordon D Ko  6
Affiliations
Review

Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

Gordon E Lawson et al. Int J Environ Res Public Health. .

Abstract

A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff's ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker.

Keywords: diagnostic facet joint blocks; facet joint; forensic medicine; medial branch blocks; neck pain; nerve block; whiplash; zygapophyseal joint.

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Conflict of interest statement

The following authors have been paid for consulting in medico-legal matters: Gordon E. Lawson, Paul S. Nolet, Gordon D. Ko. The following authors have been paid for representation in medico-legal matters: Adam R. Little, C. Adam Lawson.

Figures

Figure 1
Figure 1
Cervical facet joint schematic.
Figure 2
Figure 2
Cervical facet mediated pain radiation schematic [14].
See this image and copyright information in PMC

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References

    1. Vos T., Flaxman A.D., Naghavi M., Lozano R., Michaud C., Ezzati M., Shibuya K., Salomon J.A., Abdalla S., Aboyans V., et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–2196. doi: 10.1016/S0140-6736(12)61729-2. - DOI - PMC - PubMed
    1. Murray C., Vos T., Lozano R., Naghavi M., Flaxman A.D., Michaud C., Ezzati M., Shibuya K., Salomon J.A., Abdalla S., et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–2223. doi: 10.1016/S0140-6736(12)61689-4. - DOI - PubMed
    1. Nolet P.S., Côté P., Kristman V.L., Rezai M., Carroll L.J., Cassidy J.D. Is neck pain associated with worse health-related quality of life 6 months later? A population-based cohort study. Spine J. 2015;15:675–684. doi: 10.1016/j.spinee.2014.12.009. - DOI - PubMed
    1. Côté P., Cassidy D.J., Carroll L.J., Kristman V. The annual incidence and course of neck pain in the general population: A population-based cohort study. Pain. 2004;112:267–273. doi: 10.1016/j.pain.2004.09.004. - DOI - PubMed
    1. Hincapié C.A., Cassidy J.D., Côté P., Carroll L.J., Guzmán J. Whiplash Injury is More Than Neck Pain: A Population-Based Study of Pain Localization After Traffic Injury. J. Occup. Environ. Med. 2010;52:434–440. doi: 10.1097/JOM.0b013e3181bb806d. - DOI - PubMed