327: Prospective Outcome Review of Patients Receiving Lumbar Facet Joint Median Branch Blocks

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Treatment/management

Background and Aims: Lumbar facet joint pain is one of the most common conditions presenting to secondary care pain services and is consequently the most frequently performed intervention procedure. Current UK commissioning guidance supports a median branch block (MBB) pathway using local anaesthetic (LA) alone, with progression to radiofrequency denervation (RFD) if a positive response is demonstrated. Although osteoarthritis guidelines support steroid injections for chronic inflammatory pain, steroid use is not routinely incorporated into UK commissioning pathways for lumbar facet interventions.

Methods: Patients undergoing MBB with LA and slow release steroid returned outcome sheets recording average pain scores on the 0-10 numerical rating scale (NRS). Pain scores were recorded pre-procedure, immediately post-procedure, and at 1, 2, 4, 6 and 24 hours (LA effect) then at 1 week, 2 months, and 2 months (steroid effect). A >50% reduction in NRS was defined as a positive response. Outcomes were categorised as response to both LA and steroid, LA only, steroid only, or no response.

Results: 341 outcome sheets were analysed - 109 patients (32%) had combined response, 72 (21.1%) LA only, 50 (14.7%) steroid only and 110 (32.2%)no response.
89 patients (26.1%) proceeded to RFD, due to LA response +/- short lived steroid effect. Patients without an LA response were not offered RFD.
92 patients avoided RFD because of prolonged steroid benefit. Without steroid, 181 patients would have received RFD. Furthermore, 50 patients achieved meaningful pain reduction from steroids alone. In total, 142 patients sustained clinical benefit beyond 2 months attributable to the inclusion of a slow-release steroid.

Conclusions: The routine addition of slow-release steroids to lumbar MBB does not compromise diagnostic accuracy and provides significant clinical and service-level advantages. These include improved symptom control for a greater number of patients, reduction in rates of RFD procedures, and associated financial and theatre capacity benefits.

References: Cohen S, Doshi T, Constantinescu O, Zhao Z et al. Effectiveness of Lumbar Facet Joint Blocks and Predictive Value before Radiofrequency Denervation: The Facet Treatment Study (FACTS), a Randomized, Controlled, Clinical Trial. Anaesthesiology: 2018 September; 129(3): 517-535

NICE guideline NG59: Low back pain and sciatica in over 16s: assessment and management. Published 30 November 2016, last updated 11 December 2020.

NICE guideline NG226 Osteoarthritis in over 16s: diagnosis and management. Published 19 October 2022.

Presenting Author: Dr Kevin Fai
Submitting Author: Kevin Fai

Senior Author: Dr Kevin Fai

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr John Batty: MBBS - Maidstone and Tunbridge Wells NHS Trust
• Dr Melvin Abraham: MBBS - Maidstone and Tunbridge Wells NHS Trust
• Dr Rafiah Khan: MBBS - Maidstone and Tunbridge Wells NHS Trust