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The Prevalence of Chronic Cervical Zygapophysial Joint Pain After Whiplash

Barnsley, Leslie, BMed, PhD, FRACP; Lord, Susan M., BMedSci, BMed; Wallis, Barbara J., BA, BSc, MAPsS; Bogduk, Nikolai, MD, PhD, FAFRM

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Study Design. A survey of the prevalence of cervical zygapophysial jooint pain was conducted.

Objectives. To determine the prevalence of cervical zygapophysial joint pain in patients with chronic neck pain after whiplash.

Summary of Backgound Data. In a significant porportion of patients with whiplash, chronic, refractory neck pain develops. Provisional data suggests many of these patients have zygapophysial joint pain, but the diagnosis has been established by single, uncontrolled diagnostic blocks.

Methods. Fifty consecutive, referred patients with chronic neck pain after whiplash injury were studid using double-blind, controlled, diagnotic blocks of the cervical zygapophysial joints. On separate occasions, the joint was blocked with either lignocaine or bupivacaine in random order.

Results. A positive diagnosis was made only if both blocks relieved the patient's pain and bupivacaine provided longer relief, Painful joints were identified in 54% of the patients (95% confidence interval, 40% to 68%).

Conclusion. In this population, cervical zygapophysial joint pain was the most common source of chronic neck pain after whiplash.

From the Cervical Spine Research Unit, Faculty of Medicine, The University of Newcastle, Callaghan, Australia, and the Mater Misericordiae Hospital, Newcastle, Australia.

© Lippincott-Raven Publishers.