Cortisone Shots for Neck Pain

Study Overview
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Brief Summary
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The purpose of this study is to determine if cortisone shots in the neck are helpful in patients with certain MRI findings. Additionally, the investigators hope to learn if cervical facet joint steroid injections are beneficial in the subset of patients with MRI findings consistent with facet joint synovitis.

Official Title
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Prospective Observational Trial of Intra-Articular Cervical Zygapophyseal Joint Corticosteroid Injections in Patients With Increased Peri-Zygapophyseal Joint MRI Short Tau Inversion Recovery Signal

Conditions
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Neck Pain, Cervicalgia, Facet Joint Pain

Intervention / Treatment
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* Procedure: Intra-articular cervical zygapophyseal joint injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: at least 18 years old Patient who will be getting a neck cortisone shot for pain that has been there for at least 4 weeks A specific MRI finding (increased Short Tau Inversion Recovery signal) around 1 or more of the joints in the neck Exclusion Criteria: Those receiving disability, worker's compensation, or are involved in litigation related to their pain. Those unable to read English and complete the assessment instruments. Those unable to attend follow up appointments The patient is incarcerated. Grade 2 or greater spondylolisthesis at the involved or adjacent segments. History of prior posterior cervical surgery. Anterior cervical surgery is not an exclusion criteria. Progressive motor deficit, and/or clinical signs of myelopathy. Prior neck cortisone shots within the past 6 months. Possible pregnancy or other reason that precludes the use of fluoroscopy. Allergy to contrast media or local anesthetics. BMI>35. Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis, lupus). Active infection or treatment of infection with antibiotics within the past 7 days. Chronic widespread pain or somatoform disorder (e.g. fibromyalgia). Addictive behavior, severe clinical depression, or psychotic features.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Intra-articular cervical zygapophyseal joint injection|Fluoroscopically-guided intra-articular cervical zygapophyseal steroid injection|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Numeric Pain Rating Scale | 0 to 10 scale grading severity of pain | Baseline, 2-4 weeks, and 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck Disability Index | Measure of neck pain related disability, scored between 0-50 with 0 being no disability and higher numbers being higher levels of disability | Baseline, 2-4 weeks, and 3 months | 
| Work status | Yes or No explaining if the patient is working | Baseline, 2-4 weeks, and 3 months | 
| Medication use | Yes or No explaining if the patient is taking pain medication | Baseline, 2-4 weeks, and 3 months | 
| Use of other treatments | Yes or No explaining if the patient is using other health care resources | Baseline, 2-4 weeks, and 3 months | 
| Global Assessment of Change | Question asking if the patient is improved, the same, or worse | 2-4 weeks and 3 months |