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Percutaneous Radio-Frequency Neurotomy Treatment of Chronic Cervical Pain Following Whiplash Injury

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Percutaneous Radio-Frequency Neurotomy Treatment of Chronic Cervical Pain Following Whiplash Injury Centre for Health Services and Policy Research Percutaneous radio-frequency neurotomy treatment of chronic cervical pain following whiplash injury BCOHTA 01:5T OCTOBER 2001 British Columbia Office of Health Technology Assessment THE UNIVERSITY OF BRITISH COLUMBIA Percutaneous radio-frequency neurotomy treatment of chronic cervical pain following whiplash injury: Reviewing evidence and needs Ken Bassett MD PhD Senior Medical Consultant BC Office of Health Technology Assessment Centre for Health Services & Policy Research University of British Columbia Lyn M Sibley BSc MHA Researcher BC Office of Health Technology Assessment Centre for Health Services & Policy Research University of British Columbia Hugh Anton MD Clinical Associate Professor, Physical Medicine and Rehabilitation Head, Division of Physical Medicine and Rehabilitation G F Strong Centre University of British Columbia Philip Harrison MD Associate Professor, Radiology St. Paul's Hospital University of British Columbia Arminée Kazanjian Dr Soc Principal Investigator BC Office of Health Technology Assessment Centre for Health Services & Policy Research University of British Columbia October 2001 • BC Office of Health Technology Assessment Centre for Health Services and Policy Research University of British Columbia 429 - 2194 Health Sciences Mall Vancouver BC Canada V6T 1Z3 Tel: (604) 822-4810 Fax: (604) 822-5690 [email protected] www.chspr.ubc.ca National Library of Canada Cataloguing in Publication Data Main entry under title: Percutaneous radio-frequency neurotomy treatment of chronic cervical pain following whiplash injury “BCOHTA 01:5T” Includes bibliographical references ISBN 1-896256-15-5 1.Catheter ablation. 2. Whiplash injuries—Treatment. 3. Neck pain— Treatment. I. Bassett, Kenneth, 1952- II. British Columbia Office of Health Technology Assessment. RD531.P47 2001 617.5'304459 C2001-911515-6 © 2001 by British Columbia Office of Health Technology Assessment, The University of British Columbia Permission is granted to reproduce all or any portion of this report, providing appropriate acknowledgement is given to the authors. ii FOREWORD The British Columbia Office of Health Technology Assessment (BCOHTA) was established on December 1, 1990 by a grant from the Province to the University of British Columbia, to promote and encourage the use of assessment research in policy, planning and utilization decisions by government, health care executives, and practitioners. The Office does not participate in policy development for a requesting agency; its role is confined to appraisal of the scientific evidence. Assessments are performed in response to requests from the public sector such as hospitals, physicians, professional associations, health regions, government; private sector groups such as manufacturers; and members of the general public. One or more of the following criteria are used to determine the priority of an assessment and the level of analysis: (1) the number of users and potential change in quality of life; (2) the acquisition and operating costs to the health care system; (3) the potential to influence provider and consumer behaviour as a result of a review; and (4) the availability of accurate information and appropriate research skills. Health Technology Assessment projects are conducted by faculty and staff (including medical consultants) who are expert in systematic review methodology. Electronic bibliographic databases and fugitive literature (that is, literature not indexed or distributed publicly) are searched using predefined inclusion and exclusion criteria based on a specific search strategy. The critical appraisal of retrieved evidence includes the formulation of logical and defensible conclusions about the technology under study. Reports are reviewed internally, and then sent for external review to experts from a variety of academic or clinical disciplines. Comments and suggestions are considered before a final document is produced. Reports are available for public distribution by request or through inclusion on the mailing list; and on the Centre website. The strength of BCOHTA’s method of systematic review lies in the process of explicitly detailing the methodology and criteria used to produce recommendations, which are based solely on the research evidence. This transparent and reproducible assessment process allows other investigators to review the evidence independently and objectively. Arminée Kazanjian Dr Soc Principal Investigator, BCOHTA Copies may be obtained from: BC Office of Health Technology Assessment Centre for Health Services & Policy Research The University of British Columbia Tel: (604) 822-4810 429 - 2194 Health Sciences Mall Fax: (604) 822-5690 Vancouver, BC V6T 1Z3 http://www.chspr.ubc.ca iii ACKNOWLEDGEMENTS The observations and suggestions of the following reviewers have been extremely valuable in the preparation of this report, and their contributions are most gratefully acknowledged. Participation in the review process does not imply endorsement, however, and the British Columbia Office of Health Technology Assessment takes full responsibility for the views expressed herein. Internal Review Carolyn J Green BHSc (PT) MSc Research Co-ordinator BC Office of Health Technology Assessment University of British Columbia Vancouver, British Columbia Canada External Review Nikolai Bogduk MB BS MD PhD DSc Dip Anat Dip Pain Med FAFRM FFPM (ANZCA) Professor of Anatomy & Musculoskeletal Medicine University of Newcastle Director, Newcastle Bone and Joint Institute Royal Newcastle Hospital Newcastle, New South Wales Australia J David Cassidy PhD Associate Professor of Epidemiology & Medicine Department of Public Health Sciences Faculty of Medicine & Dentistry University of Alberta Edmonton, Alberta Canada Craig W Martin MD MHSc Senior Medical Advisor Workers’ Compensation Board of British Columbia Richmond, British Columbia Canada iv TABLE OF CONTENTS Foreword ..................................................................................................................................... iii Acknowledgements ...................................................................................................... iv Index of Tables & Figures ........................................................................................... vii EXECUTIVE SUMMARY .............................................................................................. viii INTRODUCTION ............................................................................................................ 1 1 SCOPE OF REVIEW ................................................................................................ 3 1.1 Purpose ............................................................................................................. 3 1.2 Research question ............................................................................................ 3 2 TECHNOLOGY: PRFN ............................................................................................ 4 2.1 Description ........................................................................................................ 4 2.2 PRFN positioning .............................................................................................. 5 2.3 PRFN of nerves supplying zygapophysial joints ............................................... 6 3 CLINICAL CONDITION: Chronic pain following whiplash injury ....................... 8 3.1 Definition .......................................................................................................... 8 3.2 Mechanism of injury and clinical presentation .................................................. 9 3.3 Chronic neck injury: mechanism and pathology ............................................. 10 3.4 Chronic neck injury: diagnosis ....................................................................... 12 3.5 Summary of test parameters for diagnosis .................................................... 18 4 SYSTEMATIC REVIEW METHODS ....................................................................... 19 4.1 Efficacy, effectiveness, & safety of PRFN ...................................................... 19 4.2 Epidemiology of whiplash ............................................................................... 20 4.3 BCOHTA critical appraisal methods ............................................................... 21 4.4 BCOHTA expanded evaluative framework .................................................... 21 v 5 CLINICAL EFFECTIVENESS & SAFETY FINDINGS ............................................. 23 5.1 Lord et al (1996) .............................................................................................. 23 5.2 Wallis et al (1997) ........................................................................................... 26 6 FINDINGS FROM PREVALENCE STUDIES OF CERVICAL PAIN ....................... 27 6.1 Prevalence of eligible patients in provincial insurance populations ................ 27 6.2 Prevalence of eligible patients in provincial populations ................................. 32 6.3 Prevalence estimates in clinical populations ................................................... 34 7 HEALTH IMPACT OF PRFN ................................................................................... 40 7.1 Utilization estimate .......................................................................................... 40 7.2 Patient referral ...............................................................................................
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