Anaesthesia/Wiley Research Grant
Capturing the temporal course of reported pain and its relief from diagnostic facet joint blocks to inform the prediction of successful facet-joint denervation (FAST-facet study)
Dr Michael Lee
Dr Michael Lee
Chronic low back pain is the leading cause of disability worldwide. There are few scientifically tried and tested treatments for chronic lower back pain. Amongst those recommended by the National Institute of Clinical Excellence is a procedure called lumbar facet joint denervation. The denervation procedure essentially involves burning away the nerves of the small joints in the lower back. The denervation procedure carries some risks so we need to be sure that these facet joints are the main source of back pain.
The back is a complex structure with many parts, including muscles, ligaments, joints and nerves. Pain can originate from any number of those parts. Finding out whether pain is mainly coming from the facet joints is challenging. Researchers tell us that the best approach is to inject local anaesthetic (LA) to numb the facet joints. If back pain improves, then there is a decent chance pain comes from the facet joints. The LA effects wears off quickly with time. However, research has shown that if there's a good enough effect with LA injections then subsequent denervation of the facet joints can provide significant long-term relief.
In research studies, the patient records pain daily for about a week before and after the LA injection, rather than try to remember what pain felt like weeks or even months later. The research findings are based on those recordings of pain ratings. We need similar methods of recording pain ratings in NHS pain clinics to apply research findings to our patients directly. Hence, we have developed a digital diary called Flexible Activity Symptom Tracker (FAST), which that patients can used to record pain ratings. Pain ratings can be securely recorded by telephone call, SMS (short-message-service), mobile and web apps. FAST can also be programed to generate alerts to remind patients whenever a pain rating is needed.
We now wish to see whether FAST can be used to obtain pain ratings before and after LA injection of facet joints in the busy NHS clinic similar to high quality research studies. In addition, we will use the data as they accumulate in the course of the project to see whether we improve on how pain ratings can be analysed to predict a successful denervation.
