***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Study Design . A r and omized , double-blind , active-control trial . Objective . To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain . Summary of Background Data . The prevalence of thoracic facet joint pain has been established as 34 % to 42 % . Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks , radiofrequency neurotomy , and intraarticular injections . Methods . This r and omized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids .  Outcome measures included the numeric rating scale ( NRS ) , Oswestry Disability Index ( ODI ) , opioid intake , and work status , at baseline , 3 , 6 , 12 , 18 , and 24 months . Results . Significant improvement with significant pain relief and functional status improvement of 50 % or more were observed in 80 % of the patients in Group I and 84 % of the patients in Group II at 2-year followup . Conclusions . Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin Background : Single-photon emission computed tomography ( SPECT ) is useful in identifying patients who may respond to lumbar facet injections . There are two methods for performing lumbar facet joint injections : intraarticular and medial branch nerve blocks . A consensus has yet to be reached among physicians as to which method is the most effective . The purpose of this study was to compare the effectiveness of intraarticular and medial branch nerve blocks in SPECT-positive lumbar facet joint patients with nonradicular lower back pain . Method : This study was a prospect i ve , double-blinded outcome study of 12 weeks ’ duration . Forty-six male ( 26 ) and female patients ( 20 ) between the ages of 18 and 55 ( mean 39.3 years ) with nonradicular lower back pain who were lumbar facet joint SPECT-positive were studied . No patient was included in this study if magnetic resonance imaging evidence of a lumbar disc herniation was present . Patients were r and omly assigned by computer to have intraarticular ( group I ) or medial branch nerve blocks ( group II ) with lidocaine and triamcinolone , with 23 patients in each group . Outcome measurements assessed the Numeric Pain Intensity Scores ( NPIS 0–10 ) and the Oswestry Disability Index scores ( ODI 0–50 ) . Results : There were no differences in demographics between the two groups . The percentage of pain relief ( 61 % ) and the percentage of disability ( 53 % ) reduction were significantly greater ( P < 0.05 ) in group I when compared to group II ( 26 % and 31 % respectively ) . Conclusions : Intraarticular lumbar facet joint injections are more effective than medial branch nerve blocks in SPECT-positive patients BACKGROUND Thoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34 % to 42 % of patients when the modified criteria of the International Association for the Study of Pain ( IASP ) is utilized . Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections , medial branch blocks , and radiofrequency neurotomy of thoracic medial branch nerves . STUDY DESIGN A r and omized , double-blind , active controlled trial . SETTING A private practice , interventional pain management setting , and a specialty referral center setting in the United States . OBJECTIVE To determine the clinical effectiveness of therapeutic local anesthetic medial branch blocks with or without steroid in managing chronic function-limiting mid back or upper back pain of facet joint origin . METHODS The study was performed in an interventional pain management private practice , a tertiary referral center , in the United States . A total of 100 participants were included , with 50 participants in each of the local anesthetic and steroid groups . All of the participants met the diagnostic criteria of thoracic facet joint pain by means of comparative , controlled diagnostic blocks and the inclusion criteria . Group I participants received thoracic medial branch blocks with bupivacaine , whereas Group II participants received thoracic medial branch blocks with bupivacaine and non-particulate betamethasone . OUTCOMES ASSESSMENT Outcomes measures included numeric rating scores ( NRS ) , Oswestry Disability Index ( ODI ) , opioid intake , and return to work status at baseline , 3 months , 6 months , and 12 months . Significant pain relief was defined as > /= 50 % pain relief and /or a positive change in ODI scores . RESULTS In Group I and Group II 90 % of participants showed significant pain relief and functional improvement at 12 months . The majority of the participants experienced significant pain relief of 47.2 ± 10.1 weeks in Group I and 46.3 ± 8.4 weeks in Group II , requiring approximately 3.5 treatments per year with an average relief of 15.8 ± 10.5 in Group I and 13.6 ± 3.6 weeks in Group II per episode of treatment . LIMITATIONS Study limitations include the lack of a placebo group . CONCLUSIONS Therapeutic thoracic medial branch blocks , with or without steroid , may provide a management option for chronic function-limiting mid back or upper back pain of facet joint origin . CLINICAL TRIAL NCT00355706 BACKGROUND Chronic pain in the cervical zygapohyseal joints is a common problem after whiplash injury , but treatment is difficult . Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint , but the efficacy of this treatment has not been established . METHODS In a r and omized , double-blind trial , we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on . We studied 24 patients ( 9 men and 15 women ; mean age , 43 years ) who had pain in one or more cervical zygapophyseal joints after an automobile accident ( median duration of pain , 34 months ) . The source of their pain had been identified with the use of double-blind , placebo-controlled local anesthesia . Twelve patients received each treatment . The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level . RESULTS The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group ( P=0.04 ) . At 27 weeks , seven patients in the active-treatment group and one patient in the control group were free of pain . Five patients in the active-treatment group had numbness in the territory of the treated nerves , but none considered it troubling . CONCLUSIONS In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind , placebo-controlled local anesthesia , percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief Study Design : A r and omized , active control , double-blind trial . Objective : To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome . Summary of Background Data : There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome . Methods : This active control r and omized study included 140 patients with 70 patients in each group . Group I received 0.5 % lidocaine , 10 mL ; Group II received 9 mL of 0.5 % lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone . The multiple outcome measures included the numeric rating scale , the Oswestry Disability Index 2.0 , employment status , and opioid intake with assessment s at 3 , 6 , 12 , 18 , and 24 months posttreatment . Primary outcome was defined as at least 50 % improvement in pain and Oswestry Disability Index scores . Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful . All others were considered as failures . Results : Overall in Group I , 53 % and 47 % of the patients and in Group II , 59 % and 58 % of the patients , showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months . In contrast , in the successful groups , significant pain relief and improvement in function were observed in 70 % and 62 % of Group I at one and 2 years ; in 75 % and 69 % of Group II at one and 2 years . The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief . Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II . The average procedures in the successful groups were at 4 in one year and 6 at the end of 2 years . Conclusion : Caudal epidural injections of local anesthetic with or without steroid might be effective in patients with chronic persistent low back and /or lower extremity pain in patients with post lumbar surgery syndrome Study Design : A r and omized , double-blind , controlled trial . Objective : To determine the clinical effectiveness of therapeutic lumbar facet joint nerve blocks with or without steroids in managing chronic low back pain of facet joint origin . Summary of Background Data : Lumbar facet joints have been shown as the source of chronic pain in 21 % to 41 % of low back patients with an average prevalence of 31 % utilizing controlled comparative local anesthetic blocks . Intraarticular injections , medial branch blocks , and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin . Methods : The study included 120 patients with 60 patients in each group with local anesthetic alone or local anesthetic and steroids .  The inclusion criteria was based upon a positive response to diagnostic controlled , comparative local anesthetic lumbar facet joint blocks . Outcome measures included the numeric rating scale ( NRS ) , Oswestry Disability Index ( ODI ) , opioid intake , and work status , at baseline , 3 , 6 , 12 , 18 , and 24 months . Results : Significant improvement with significant pain relief of ≥ 50 % and functional improvement of ≥ 40 % were observed in 85 % in Group 1 , and 90 % in Group II , at 2-year follow-up . The patients in the study experienced significant pain relief for 82 to 84 weeks of 104 weeks , requiring approximately 5 to 6 treatments with an average relief of 19 weeks per episode of treatment . Conclusions : Therapeutic lumbar facet joint nerve blocks , with or without steroids , may provide a management option for chronic function-limiting low back pain of facet joint origin STUDY DESIGN A prospect i ve double-blind r and omized trial in 31 patients . OBJECTIVES To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain , functional disability , and physical impairment in patients with back pain originating from the lumbar zygapophysial joints . SUMMARY OF BACKGROUND DATA Chronic low back pain is a major health problem in the industrialized world . A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints . Its clinical efficacy has never been formally tested in a controlled trial . METHODS Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently r and omly assigned to one of two treatment groups . Each patient in the radiofrequency treatment group ( 15 patients ) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3 , L4 , and L5 . Patients in the  control group ( n = 16 ) underwent an the same procedure but without use of a radiofrequency current . Both the treating physician and the patients were blinded to the group assignment . Before treatment , physical impairment , rating of pain , the degree of disability , and quality of life were assessed by a blinded investigator . RESULTS Eight weeks after treatment , there were 10 success patients in the radiofrequency group ( n = 15 ) and 6 in the sham group ( n = 16 ) . The unadjusted odds ratio was 3.3 ( P = 0.05 , not significant ) , and the adjusted odds ratio was 4.8 ( P < 0.05 , significant ) . The differences in effect on the visual analog scale scores , global perceived effect , and the Oswestry disability scale were statistically significant . Three , 6 , and 12 months after treatment , there were significantly more success patients in the radiofrequency group compared with the sham group . CONCLUSIONS Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain , both on a short-term and a long-term basis Background The literature is 
    Output:
    
Secondary outcome measures were improvement in functional status , psychological status , return to work , and reduction in opioid intake consumption .
In the cervical spine , for long-term improvement , there is Level II evidence for cervical radiofrequency neurotomy and cervical facet joint nerve blocks , and Level IV evidence for cervical intraarticular injections .
In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency neurotomy for long-term improvement .
Based on the present assessment for the management of spinal facet joint pain , the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency neurotomy , and therapeutic facet joint nerve blocks in the cervical , thoracic , and lumbar spine ; Level III for lumbar intraarticular injections ; and Level IV for cervical intraarticular injections and thoracic radiofrequency neurotomy