Facet Versus Trigger Point Injections for Chronic Neck Pain

NCT ID: NCT01808586

Last Updated: 2018-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

43 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-05-31

Study Completion Date

2016-12-31

Brief Summary

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A) Background Chronic neck pain is a significant and common issue which is difficult to treat. Tight bands of muscle (trigger points) can be a source of chronic neck pain and they are sometimes injected to manage chronic neck pain. However, these injections seldom lead to significant, long-lasting relief. In some cases, these trigger points may originate from injury or damage to a specific joint in the neck (the facet joint). Treatment of this joint with cortisone injection may lead to improved pain relief and function.

B) Hypothesis By injecting the facet joint with cortisone, the pain associated with tight bands of muscle in the neck and shoulders will be relieved to a greater extent than that attained through trigger point injection.

C) Methods Patients with neck pain will have a test to determine if any pain originates from the facet joint. Among those who have significant pain from these joints, a comparison between the effect of cortisone injection into these joints versus injection into the trigger points will be evaluated.

D) Expected Results and Significance

It is expected that injection with cortisone into the facet joints will lead to improved pain and function when compared to that attained from trigger point injection. In addition, the number of trigger points, and the pain and headache that originate from these trigger points, are expected to decrease with cortisone injection into the facets to a statistically and clinically significant extent. Results from this pilot study will then influence the design of future trials into chronic neck pain treatment, leading to better clinical recommendations. A peer-reviewed publication and conference presentations will facilitate dissemination.

Detailed Description

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Conditions

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Neck Pain

Keywords

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Neck chronic pain facet injection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Dexamethasone

Intra-articular corticosteroid number 2.

Group Type EXPERIMENTAL

Dexamethasone

Intervention Type PROCEDURE

4mg/mL

Betamethasone

Subjects will receive either betamethasone or dexamethasone injected into the cervical facet joints (levels determined by experienced physician).

Group Type EXPERIMENTAL

Betamethasone

Intervention Type PROCEDURE

6 mg/mL injected into the facet joint as dictated by modified dual-comparative medial branch block diagnostic protocol

Intramuscular injection

Subjects in this group will receive lidocaine injection directly into tender myofascial trigger points.

Group Type ACTIVE_COMPARATOR

Intramuscular Lidocaine

Intervention Type PROCEDURE

2%

Home exercise

Subjects in this group will receive education and a pamphlet on a set of standardized home exercises for neck pain

Group Type ACTIVE_COMPARATOR

Home Exercise

Intervention Type BEHAVIORAL

Standardized home exercise program

Interventions

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Betamethasone

6 mg/mL injected into the facet joint as dictated by modified dual-comparative medial branch block diagnostic protocol

Intervention Type PROCEDURE

Dexamethasone

4mg/mL

Intervention Type PROCEDURE

Intramuscular Lidocaine

2%

Intervention Type PROCEDURE

Home Exercise

Standardized home exercise program

Intervention Type BEHAVIORAL

Other Intervention Names

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Betaject/Celestone

Eligibility Criteria

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Inclusion Criteria

* between 18 and 65 years of age and able to speak and understand conversational English
* Primary diagnosis of chronic (\>6 months) mechanical / myofascial neck pain

Exclusion Criteria

* Those with significant cognitive decline or cognitive interference (as identified by the physician) will be excluded, as will those who have received radiofrequency ablation of any cervical nerve within the past year, intra-articular cortisone facet injection within the past 4 months, trigger point injection into the cervical/shoulder girdle muscles within the past 4 months, or the presence of any known contraindication to injection (Attachments).
* Women who are or may be pregnant (based on last menstruation) will be excluded.
* Finally, for the purposes of this pilot study, those currently involved in active litigation regarding the neck pain will be excluded. Those with active worker's compensation claims or currently receiving salary indemnity benefits through motor vehicle insurance providers will be included, as they represent a significant proportion of this population.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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London Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph's

OTHER

Sponsor Role lead

Responsible Party

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Dave Walton

Principle Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David M Walton, BScPT, PhD

Role: PRINCIPAL_INVESTIGATOR

Western University, Canada

Locations

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St. Joseph's Hospital / Parkwood Hospital

London, Ontario, Canada

Site Status

Countries

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Canada

Other Identifiers

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2982

Identifier Type: -

Identifier Source: org_study_id