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Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation

1
Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada
2
Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
3
Oatley Vigmond LLP, Barrie, ON L4M 6C1, Canada
4
Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2 W1, Canada
5
Shibley Righton LLP, Toronto, ON M5H 3E5, Canada
6
Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(21), 7932; https://doi.org/10.3390/ijerph17217932
Received: 23 September 2020 / Revised: 22 October 2020 / Accepted: 26 October 2020 / Published: 29 October 2020
(This article belongs to the Special Issue Forensic Epidemiology)
A commonly disputed medicolegal issue is the documentation of the location, degree, and anatomical source of an injured plaintiff’s ongoing pain, particularly when the painful region is in or near the spine, and when the symptoms have arisen as result of a relatively low speed traffic crash. The purpose of our paper is to provide health and legal practitioners with strategies to identify the source of cervical pain and to aid triers of fact (decision makers) in reaching better informed conclusions. We review the medical evidence for the applications and reliability of cervical medial branch nerve blocks as an indication of painful spinal facets. We also present legal precedents for the legal admissibility of the results of such diagnostic testing as evidence of chronic spine pain after a traffic crash. Part of the reason for the dispute is the subjective nature of pain, and the fact that medical documentation of pain complaints relies primarily on the history given by the patient. A condition that can be documented objectively is chronic cervical spine facet joint pain, as demonstrated by medial branch block (injection). The diagnostic accuracy of medial branch blocks has been extensively described in the scientific medical literature, and evidence of facet blocks to objectively document chronic post-traumatic neck pain has been accepted as scientifically reliable in courts and tribunals in the USA, Canada and the United Kingdom. We conclude that there is convincing scientific medical evidence that the results of cervical facet blocks provide reliable objective evidence of chronic post-traumatic spine pain, suitable for presentation to an adjudicative decision maker. View Full-Text
Keywords: forensic medicine; neck pain; nerve block; whiplash; zygapophyseal joint; medial branch blocks; diagnostic facet joint blocks; facet joint forensic medicine; neck pain; nerve block; whiplash; zygapophyseal joint; medial branch blocks; diagnostic facet joint blocks; facet joint
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MDPI and ACS Style

Lawson, G.E.; Nolet, P.S.; Little, A.R.; Bhattacharyya, A.; Wang, V.; Lawson, C.A.; Ko, G.D. Medial Branch Blocks for Diagnosis of Facet Joint Pain Etiology and Use in Chronic Pain Litigation. Int. J. Environ. Res. Public Health 2020, 17, 7932.

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