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For patients with chronic low back pain, lumbar facet blocks sometimes are used diagnostically (to predict response to a more definitive procedure, radiofrequency denervation) and sometimes are used therapeutically. Two types of lumbar facet blocks are injections of local anesthetic and steroid into facet joints (intra-articular injection) and injections into the area of the nerves supplying facet joints (medial branch block).
In this complicated study, 229 patients with chronic low back pain, but without spinal stenosis or neurological findings, were randomized to receive intra-articular facet injections or medial branch blocks (both with bupivacaine plus steroid) or saline placebo. Patients in either active-treatment group were significant…