A facet joint block is a diagnostic injection of local anesthetic near the small joints at the back of the neck. If the pain stops when the joint is numbed, and does not stop with a placebo, that joint is the likely pain source. Done this way, blocks have shown that the facet joints are the source of chronic neck pain in a majority of whiplash patients studied. I refer patients in Charlotte for this test when the exam points to the facets and pain has not resolved.
How the Test Was Validated
Lord and colleagues studied 68 consecutive patients with neck pain lasting more than three months after whiplash (Lord, Spine 1996). Each patient received two different local anesthetics and a saline placebo at the suspected joint, in random order, without knowing which was which. A joint counted as the pain source only if both anesthetics relieved the pain and the placebo did not.
By that standard, 60% of patients had facet joint pain, with a 95% confidence interval of 46% to 73%. Among patients whose main complaint was headache, the C2-C3 joint was the source in 50%. The placebo step matters. A single anesthetic injection with no placebo would have counted patients who improved for reasons unrelated to the joint.
Why the Facets Are Vulnerable
Each facet joint is wrapped in a capsule, which is a ligament. In cadaver spines subjected to a simulated rear impact, the capsular ligaments from C2-C3 to C7-T1 elongated significantly more under load than controls (Ivancic, Clin Biomech 2008). That is laboratory evidence that the capsule can be stretched in a whiplash mechanism, which fits with the joint becoming a pain source.
What Treatment Showed
The same research group then tested radiofrequency neurotomy, which uses heat to interrupt the small nerves that carry pain from the joint (Lord, N Engl J Med 1996). Twenty-four patients with facet pain after a car accident, confirmed with placebo-controlled blocks, were randomized to the real procedure or an identical sham with the current off. The median time until pain returned to half its original level was 263 days with the real procedure and 8 days with the sham. At 27 weeks, 7 patients in the treatment group and 1 in the sham group were pain-free. Five treated patients had numbness over the treated nerves, which none found troubling.
It was a small trial, and the relief was lasting rather than permanent. It remains one of the few sham-controlled treatment trials in chronic whiplash.
When I Refer for Blocks
About 50% of people with whiplash-associated disorders still report neck pain a year after injury (Carroll, Spine 2008). For a patient whose pain has persisted past the expected recovery window, whose exam localizes pain to the facets, and who has not responded to conservative care, a referral to a pain specialist for controlled blocks can identify the source. The blocks are a test first. Treatment decisions follow from the result.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What is a facet joint block?
A facet joint block is a diagnostic injection of local anesthetic near the small joints at the back of the spine. If pain stops with the anesthetic and not with a placebo, the joint is the likely pain source.
How often are the facet joints the cause of chronic neck pain after whiplash?
In a placebo-controlled study of 68 patients with chronic neck pain after whiplash, the facet joints were the pain source in 60% (Lord, Spine 1996).
Can facet joints cause headaches after whiplash?
Yes. Among patients whose main complaint was headache, the C2-C3 facet joint was the source in 50% (Lord, Spine 1996).
What is radiofrequency neurotomy?
It uses heat to interrupt the nerves carrying pain from a facet joint. In a sham-controlled trial, median time to pain returning to half its original level was 263 days versus 8 days with sham (Lord, N Engl J Med 1996).
When does Dr. Justin Dick refer for facet blocks?
Dr. Justin Dick in Charlotte, NC refers to a pain specialist when pain persists past the expected recovery window, the exam localizes it to the facets, and conservative care has not resolved it.
Where can I get chronic neck pain after whiplash evaluated in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash: a placebo-controlled prevalence study. Spine. 1996;21(15):1737-1744. PMID 8855458. LinkEvidence tier: Placebo-controlled diagnostic prevalence study (68 patients)
- Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996;335(23):1721-1726. PMID 8929263. LinkEvidence tier: Randomized double-blind sham-controlled trial (24 patients)
- Ivancic PC, Ito S, Tominaga Y, et al. Whiplash causes increased laxity of cervical capsular ligament. Clin Biomech. 2008;23(2):159-165. PMID 17959284. LinkEvidence tier: Cadaveric laboratory study (mechanistic)
- Carroll LJ, Holm LW, Hogg-Johnson S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force. Spine. 2008;33(4 Suppl):S83-S92. PMID 18204405. LinkEvidence tier: Best evidence synthesis (systematic review)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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