Inclusion Criteria:  Consenting patients over 18 years of age undergoing cervical medial branch blocks as part of their usual care and who have a pain intensity of at least 5/10 (at rest or on movement) and a pain duration of at least 4 months.  Exclusion Criteria:  Inability to communicate or complete follow up questionnaires Known bleeding disorder or coagulopathy Patients on antiplatelet medication other than aspirin and those on anticoagulants (coumadin, AT III agents) Inability to visualize targeted structures on ultrasound Presence of acute radiculopathy of new onset neurological symptoms in the upper extremities Patients with bilateral neck pain if only one side is treated