Osteoarthritis of zygapophysial joints as a cause of back pain and neck pain: a scoping review.

Background: Zygapophysial joints (Z joints) can be a source of back pain and of neck pain, but the cause of pain is not known. Some authors attribute the pain to osteoarthritis but without citing evidence.

Objectives: The present review was undertaken to determine if there was sufficient evidence of association between spinal pain and osteoarthritis of Z joints to justify osteoarthritis being held to be the cause of pain.

Athrodesis of the lateral atlanto-axial joint for the relief of neck pain and cervicogenic headache.

Background: Osteoarthrosis of the lateral atlanto-axial joint (LAAJ) may be a cause of upper neck pain and headache. Intra-articular injection of steroids may provide only short-lasting relief. For intractable pain, arthrodesis of the joint might be considered.

On understanding reliability for diagnostic tests.

For professional practice to be responsible, any diagnostic tests used must be reliable. Therefore, the reliability of any diagnostic test needs to have been measured. The classical statistic for quantifying reliability is Kappa.

On comparing groups in studies of pain treatment.

Studies of pain treatment involve comparing groups. In observational studies scores for outcome variables in the one group are compared before and after treatment. In controlled trials, scores are compared between groups undergoing different treatments.

Calibrating effect-size for studies of pain treatment.

Effect-size is a statistic often used in studies of pain treatment. Its attraction is that numerical values can be translated into adjectives, such as small, medium, and large, that describe the change in scores for outcome measures. However, these adjectives can be misused to imply that the effectiveness of the treatment is the equivalent of small, medium, or large.

Criteria for determining if a treatment for pain works.

Claims that a treatment works are hollow unless qualified in terms of: in what respects, by how much, how often, and for how long. Essential co-requisites for improvements in pain are improvements in function, psychological distress, and use of health care. Validated instruments are available for these outcome measures.

On understanding the validity of diagnostic tests.

For clinical practice to be professionally responsible, any diagnostic tests used need to be valid because, if a test lacks validity the information that it provides is wrong. Of the several subtypes of validity, the crucial one is construct validity, which determines how well a diagnostic test discriminates simultaneously between the presence and the absence of the condition being diagnosed. Its key parameters are the sensitivity and specificity of the test, and its (positive) likelihood ratio.

The Prevalence of "Pure" Lumbar Zygapophysial Joint Pain in Patients with Chronic Low Back Pain.

Background: Estimates of the prevalence of lumbar zygapophysial joint (Z joint) pain differ in the literature, as do case definitions for this condition. No studies have determined the prevalence of "pure" lumbar Z joint pain, defined as complete relief of pain following placebo-controlled diagnostic blocks.

Objective: The objective of this study was to estimate the prevalence of "pure" lumbar Z joint pain.

Sources of Cervicogenic Headache Among the Upper Cervical Synovial Joints.

Objectives: The study sought to assess the utility of controlled diagnostic blocks in patients with probable cervicogenic headache by determining the prevalence of sources of pain among the upper and lower synovial joints of the cervical spine.

Methods: Controlled diagnostic blocks were performed in 166 consecutive patients who clinically exhibited features consistent with a diagnosis of probable cervicogenic headache. Data were collected on how often a particular source of pain could be pinpointed and how often particular diagnostic blocks provided a positive yield.

The Effectiveness of Cervical Medial Branch Thermal Radiofrequency Neurotomy Stratified by Selection Criteria: A Systematic Review of the Literature.

Objective: To determine the effectiveness of cervical medial branch thermal radiofrequency neurotomy in the treatment of neck pain or cervicogenic headache based on different selection criteria.

Design: Comprehensive systematic review.

Methods: A comprehensive literature search was conducted, and the authors screened and evaluated the studies.

Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique.

Objective: To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques.

Design: Comprehensive systematic review.

Methods: A comprehensive literature search was conducted, and all authors screened and evaluated the studies.

Update of a Study of Not Ceasing Anticoagulants for Patients Undergoing Injection Procedures for Spinal Pain.

Objectives: To determine prevalence rates of hemorrhagic complications in patients who either ceased or continued anticoagulants during interventional pain procedures.

Methods: A total of 1,936 consecutive patients were prospectively monitored during a total of 12,723 injection procedures. The prevalence of hemorrhagic complications was tallied for a variety of procedures performed on patients who ceased or continued various anticoagulants.

The Costs of Confronting Osteoporosis: Cost Study of an Australian Fracture Liaison Service.

Fracture liaison services (FLS) are an accepted approach to lowering rates of osteoporotic refractures. However, resource allocations to FLS are open to challenge, as most relevant cost analyses are based on anticipated, rather than observed, benefits. To support informed decision making, we have estimated the cost of operating an FLS, from the perspective of the Australian health system, with real life costs.

Cervical Discs as a Source of Neck Pain. An Analysis of the Evidence.

Objectivesbackground: Objectives To determine the extent and strength of evidence that supports the belief that cervical intervertebral discs are a source of neck pain.

Design: Design The evidence from anatomical, laboratory, experimental, diagnostic, and treatment studies was summarized and analyzed for concept validity, face validity, content validity, and construct validity.

Results: Results Evidence from basic sciences shows that cervical discs have a nociceptive innervation, and experimental studies show that they are capable of producing neck pain.