Cervical Plexus block in Chronic Neck Pain from Whiplash Injury
Research type
Research Study
Full title
Effectiveness of ultrasound guided Intermediate Cervical Plexus Block (iCPB) in patients with refractory chronic neck pain from Whiplash Associated Disorder (WAD): an observational pilot study
IRAS ID
276705
Contact name
Niraj Gopinath
Contact email
Sponsor organisation
University Hospitals of Leicester NHS Trust
Duration of Study in the UK
3 years, 0 months, 0 days
Research summary
Whiplash is the most common injury associated with motor vehicle accidents and a major cause of disability and litigation. Patients commonly present with neck pain. Chronic whiplash syndrome is characterized by symptoms of neck pain that persist for more than 3 months and this is often refractory to management (pain relief medications, physiotherapy). There is new evidence to show that the pain in whiplash injury could be due to an impaired function of the neck muscles arising from whiplash trauma and is called cervico-thoracic myofascial pain syndrome. Current treatment for this condition is injection of numbing medicine and steroids directly into the muscle (usually 4-12 injections). Although this treatment is safer than burning the facet joint nerves, it provides short term relief (2-3 months).
We have shown that a novel treatment (cervical plexus block, CPB). targeting the nerves that supply the muscles in the neck can provide durable relief (6 months). We currently offer CBP treatment as a standard treatment.
Aim of the study is to evaluate the effectiveness of Cervical Plexus Block (CPB) treatment in pain at six months post treatment in patients with whiplash injury
Methods: The proposed study is a prospective, observational pilot study that will be conducted at Leicester General Hospital over 36 months. Participants will be given an information sheet when they are seen in the out-patient clinic. The participants will have 24 hours to read the sheet. Thereafter, the research team will approach the potential participant to obtain informed consent. After providing written consent, adult patients with chronic neck pain from whiplash injury will receive CPB in theater. If CPB provides no benefit, the participants will receive a rescue treatment (trigger point injection). Participants will be asked to complete questionnaires on pain score. Participation will end at 9 months following the CPB treatment.
Lay summary of study results: Whiplash injury can result in a range of symptoms including chronic neck pain, headache, face pain, upper back pain and ringing in the ear that comprises whiplash-associated disorder. Intermediate cervical plexus block is a novel intervention that targets the upper cervical nerves and anecdotal reports suggest benefit in patients suffering from whiplash-associated disorder. We hypothesized that the cervical plexus may have a role in the development of whiplash-associated disorder and blocking the cervical plexus nerves may provide painrelief.
Adult patients who presented with refractory chronic neck pain following whiplash were included in a prospective observational trial. The pragmatic trial studied the effectiveness of two sequential cervical plexus blocks (intermediate cervical plexus block with local anaesthetic and intermediate cervical plexus block with steroid and local anaesthetic mixture) in refractory chronic neck pain following whiplash. Patients who reported <50% relief at 12 weeks after intermediate cervical plexus block with local anaesthetic were offered intermediate cervical plexus block with steroid and local anaesthetic mixture. Primary outcome was ‘Neck pain at its worst in the last 24 hours’ at 12 weeks. Secondary outcomes included change in neck disability index, employment status and mood.
After excluding neck joint dysfunction, 50 patients underwent the intermediate cervical plexus block with local anaesthetic between June 2020 and August 2022. Five patients reported >50% relief (durable relief) at 12 weeks and three patients were lost to follow-up. Forty-two patients received intermediate cervical plexus block with steroid and local anaesthetic mixture. Intermediate cervical plexus block with steroid was associated with significant reduction in neck pain, neck disability and improvement in mood at 12 weeks when compared to the block with local anaesthetic. In addition, intermediate cervical plexus block with steroid was associated with significant reduction in neck pain and disability at 24 weeks. Due to functional improvement, 34 patients (34/50, 78%) were able to maintain employment.
Cervical plexus could play a central role in the development of whiplash-associated disorder. Intermediate cervical plexus block could potentially be a treatment option in this cohort.REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
20/EM/0075
Date of REC Opinion
30 Mar 2020
REC opinion
Further Information Favourable Opinion