As you know, pain of spinal origin is a common source of long-term disability. When conservative measures have not produced the desired level of pain relief, one of the pain management options available to your patients by referral to Care Medical Center is facet joint injections. Pain with facet joint involvement is often characterized by pain in the paraspinal region, buttocks, thigh, or shoulder.(1) Other signs include pain worsened on hyperextension followed by flexion, pain accompanied by paraspinal tenderness, and aggravation of pain on valsalva.(2) However, facet joint injections are often considered diagnostic as well as therapeutic, making the procedure appropriate when uncertainty exists over the origin of back pain. Facet involvement may be obvious on radiographic examination such as in the case of facets overgrown and deformed by osteophytes, but facet involvement may also be a factor in cases where facet joints appear normal such as in cases of radiologically occult syonovitis.
Medical practitioners making referrals for possible facet block treatments can expect a high level of patient satisfaction. Multiple reviews conclude that there is moderate evidence for the efficacy of facet joint injections.(3-5) Among patients pre-qualified as having pain with facet joint involvement, greater than 80% typically experience a reduction of pain of 50% or greater. Manchikanti, MD and colleagues provided facet joint injections to 100 consecutive patients with chronic neck pain. Their study added two interesting aspects to the usual pain relief measurements. They also measured that recipients of this treatment had reduced depression and that unemployment dropped from 30% to 10%.(6)
Facet joint injections involve injecting small doses of steroids and/or local anesthetic into the facet joint. We use fluoroscopic guidance to ensure efficacy and safety. Pain relief is immediate. Patients typically require three to four treatments per year for consistent relief.
References:
1. Safriel Y. Lumbar and cervical pain management procedures: When and how to do them. Applied Radiology. 2010; 39 (12): 14-23.
2. Schwarzer A, Aprill C, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994: 15; 19:1132-1137.
3. Atluri S, Datta S, Falco F, Lee M. Systematic review of diagnostic utility and therapeutic effectiveness of thoracic facet joint interventions.
4. Manchikanti L, Boswell M, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 2009: 12: 699-802.
5. Boswell M, Colson J, Sehgal N, et al. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007 Jan; 10 (1): 229-53.
6. Manchikanti L, Singh V, Falcoi F, et al. cervical medial branch blocks for chronic cervical facet joint pain: a randomized, double-blind, controlled trial with one-year follow-up. Spine. Aug 1 2008; 33 (17): 1813-20.
For Your Health,
Dr. Ryan Moorman
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