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

Gordon E. Lawson, Paul S. Nolet, Adam R. Little, Anit Bhattacharyya, Vivian Wang, C. Adam Lawson and Gordon D. Ko
Additional contact information
Gordon E. Lawson: Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada
Paul S. Nolet: 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
Adam R. Little: Oatley Vigmond LLP, Barrie, ON L4M 6C1, Canada
Anit Bhattacharyya: Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2 W1, Canada
Vivian Wang: Canadian Memorial Chiropractic College, Toronto, ON M2H 3J1, Canada
C. Adam Lawson: Shibley Righton LLP, Toronto, ON M5H 3E5, Canada
Gordon D. Ko: Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada

IJERPH, 2020, vol. 17, issue 21, 1-13

Abstract: 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.

Keywords: forensic medicine; neck pain; nerve block; whiplash; zygapophyseal joint; medial branch blocks; diagnostic facet joint blocks; facet joint (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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