Do any of you guys have significant success treating subacute/chronic myofascial pain following MVAs?
Do MBB/IA facet/RFAs really work for these people?
Do MBB/IA facet/RFAs really work for these people?
Myofascial pain
- Thread starter Dr. Ice
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The pathology is less important than the motivation to get better.
I've had workers comp whiplash injuries return to work after a single MBB and pain free/case closed. Was it the injection, the timing, or the 60% of prior pay that got her better? Probably 2/3 and I'm pretty sure it wasn't the injection.
I've had workers comp whiplash injuries return to work after a single MBB and pain free/case closed. Was it the injection, the timing, or the 60% of prior pay that got her better? Probably 2/3 and I'm pretty sure it wasn't the injection.
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dont u try Trigger Point injections with these people! I hv done some TPI with 1% lido with good success and ditto lobe.
in the older patient without pending litigation, yes.
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yes, definitely works! As someone else stated Trigger Points and even Synera works.
These are some of the most painful patients to treat, because you just don't get that positive outcome like you do with acute radics and other painful conditions that typically resolve.
If picture may be consistent with facet pain, we'll talk about doing medial branch blocks. But before I do anything invasive the patient and I have already talked about the right exercise program, addressing stress in their life (which includes ongoing litigation), improving sleep, optimizing mental health disorders, etc.
I think this has already been discussed on other threads but the meds I discuss with patients are the usual TCAs, NSAIDs, flexeril, scheduled Tylenol, and avoid opioids.
If picture may be consistent with facet pain, we'll talk about doing medial branch blocks. But before I do anything invasive the patient and I have already talked about the right exercise program, addressing stress in their life (which includes ongoing litigation), improving sleep, optimizing mental health disorders, etc.
I think this has already been discussed on other threads but the meds I discuss with patients are the usual TCAs, NSAIDs, flexeril, scheduled Tylenol, and avoid opioids.
No. I cringe when I see that its an MVA patient (but the worst is a WC MVA). I do all the usual stuff (PT, TENS, NSAIDS, Muscle relaxants, lidoderm), then try TPIs. Then F/E xrays and MRI if no better. I move on to facets if indicated. After that, I tell them to tell their attorney that this isn't getting better. I recommend a second opinion if they want it. Then I run in the opposite direction as fast as humanly possible.
no. i personally dont think they are indicated for post-MVA. very very rarely work
with bonafide myofascial pain syndrome (not just "ouch, that hurts when you touch there"), ill try some TPIs if there are good trigger points.
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I skip TPI.s I use TENS, PT, SMR (Zanaflex or Skelaxin mostly) and go to MBB after 1-2 weeks of therapy. Get em in, get em out.
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Chiropractic treatment may be best, then again it may not. Maybe we should discuss it.
JUST KIDDING!!!!! let's not revisit
JUST KIDDING!!!!! let's not revisit
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Define "significant." 😀
IA FJI - some success
MBB - some success as a test
RFA - rare success in MVA pts.
As Steve says, it's all about the motivation to get better. Money is the universal motivator.
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This. Sporadic younger folk too.
Generally, lots of handholding, PT, NSAID du jour, +/- Robaxin if not ancient, fall risk, etc.
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Yes and probably.
if you do facet work in all of your MVA patients, you will be a busy man who gets poor results.
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in the last 3 years, i have only had 3 patients have great success with cervical RFs for post-whiplash pain.... all 3 of those patients were over 65...
to date, i have not had ANY patient s/p MVA who is actively involved in litigatino get ANY benefit from an RF.... however, surprisingly i have a very high success rate w/ MBBs in this population.... why do they get relief w/ MBB but not RF?
i am starting to suspect that the lawyers see the relief w/ MBB as a diagnostic validation that they had a facet injury and can increase the claim... because for the most part, these are healthy patients, with healthy necks (quite unremarkable on exam except for the "cervical tenderness") and pristine MRI/CT imaging...
another reason why I hate PI --- it ain't medicine... those visits are all medico-legal visits.
to date, i have not had ANY patient s/p MVA who is actively involved in litigatino get ANY benefit from an RF.... however, surprisingly i have a very high success rate w/ MBBs in this population.... why do they get relief w/ MBB but not RF?
i am starting to suspect that the lawyers see the relief w/ MBB as a diagnostic validation that they had a facet injury and can increase the claim... because for the most part, these are healthy patients, with healthy necks (quite unremarkable on exam except for the "cervical tenderness") and pristine MRI/CT imaging...
another reason why I hate PI --- it ain't medicine... those visits are all medico-legal visits.
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I would counter that their pain is real, as evidenced by positive MBB, but fear of loss of the claim by the patients alone (w/o lawyer input) is what keeps the RFA from working. If you relieve their pain permanently, they have to go back to work and be productive, and their lawsuit lottery ticket is invalidated.
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In the whiplash/post MVA patients I've had some success doing intra-articular facets on the young (with normal facets on MRI), and MBB/RF on older patients (with moderate-advanced facet disease on MRI).
However, my rate of success is much better if I hold off on doing either facet procedure for at least 6-8 weeks or longer after their MVA to give the soft tissues time to heal while prescribing the usual conservative measures that everyone mentioned above. Everything looks deceptively like facet mediated pain for the first several months after an MVA.
However, my rate of success is much better if I hold off on doing either facet procedure for at least 6-8 weeks or longer after their MVA to give the soft tissues time to heal while prescribing the usual conservative measures that everyone mentioned above. Everything looks deceptively like facet mediated pain for the first several months after an MVA.
