Injection and ablation therapies for chronic nonspecific neck pain

Various types of injections have been used to treat chronic nonspecific neck pain, including trigger point injections at sites of maximal tenderness with a corticosteroid or botulinum A toxin. However, there is no evidence that these therapies provide definite benefit. Patients should be made aware that significant harms are associated with corticosteroid injections for chronic nonspecific neck pain.

Injection and ablation techniques targeting putative structural causes of chronic neck pain, such as the cervical facet joints, are sometimes used. Pain relief from injection of local anaesthetic into the putatively painful joint(s), or from blocking their nerve supply via medial branch blocks, may identify the source of neck pain and provide the rationale for percutaneous radiofrequency denervation. The proponents of these techniques assert that meticulous identification of appropriate patients is required and that these techniques should only be undertaken by skilled treatment providers in specialist centres. Decisions to investigate chronic nonspecific neck pain for therapeutic purposes should be coordinated by specialists; current evidence does not justify widespread use of this approach.