The effectiveness of corticosteroid injection into cervical facet joint for managing whiplash-related neck pain

Abstract

Background: Cervical facet joint (CFJ) pain is commonly seen after whiplash trauma, and is frequently refractory to physical therapy and oral medication. Previous studies have shown positive pain- reducing outcomes after intra-articular (IA) corticosteroid injection in patients with CFJ pain unrelated to injury. We evaluated the effectiveness of IA corticosteroid injection for managing whiplash-related CFJ pain. Methods: We prospectively recruited 32 patients with chronic and persistent CFJ pain after whiplash trauma [>= 3 on the Numeric Rating Scale (NRS)] despite physical therapy and oral medication. Under fluoroscopy guidance, we injected 10 mg (0.25 mL) of triamcinolone acetonide, mixed with 0.25 mL of 0.125% bupivacaine and 0.5 mL of normal saline. At 1 and 2 months after the injection, pain intensity was reassessed using the NRS. Results: Thirty patients completed the study. The mean pretreatment NRS score was 5.4 +/- 1.7, while the mean NRS scores at 1 and 2 months after treatment were 3.9 +/- 1.7 and 4.0 +/- 1.6, respectively. The NRS scores at both follow-ups were significantly decreased compared to pretreatment scores (pretreatment vs. 1 month, P=0.002; pretreatment vs. 2 months, P=0.004). Furthermore, 8 patients (26.7%) reported pain relief of =50% 2 months after the treatment. Conclusions: In clinical practice, whiplash- induced CFJ pain is often refractory to physical therapy and oral medication, and clinicians have limited options to alleviate pain. We think that IA corticosteroid injection may serve as a management option for whiplash-related CFJ pain.