dont u try Trigger Point injections with these people! I hv done some TPI with 1% lido with good success and ditto lobe.
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.
Do MBB/IA facet/RFAs really work for these people?
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.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.