Treatment of Facet Joint Pain

May 19, 2014December 11, 2015 / Thomas Cohn, MD

Facet joints, also known as zygoaphoseal joints, are the posterior joints that articulate on each side of the spine between each vertebral body. The joints are at each level of the cervical, thoracic and lumbar spine.

The facet joints are similar to the joints in your fingers. The wear and tear of the finger joints is similar to what happens in the rest of the body, but in the back it is caused by increased weight carried by these joints in the cervical and lumbar regions. Degeneration often occurs starting at about age 30, but trauma can cause earlier changes to these joints.

Diagnosing Facet Joint Pain

The facet joints can cause pain. The pattern of pain for the neck joints has been mapped out by extensive studies. The thoracic and lumbar region have less defined patterns of pain but are generally midline at about the level of the problem. Unfortunately, imaging studies like MRI scans and CT scans often do not show changes in these joints that correlate to pain. If the discs in the spine have degenerated at a certain level, the space between the bones is decreased. Definitive diagnosis of facet joint pain can only be made through diagnostic nerve blocks to the joints.

The initial management of suspected facet joint pain is always conservative. Acute pain often responds to a variety of treatments, including:

Chiropractic adjustments
Massage
Physical therapy
Heat and ice
Stretching

Nonsteroidal anti-inflammatory medications like naproxen or ibuprofen and crèmes can also be very effective. Acute pain often responds to the above measures within a short period of time.

Prolonged Pain

Facet pain and spinal pain that continues for more than six months often needs more aggressive treatment if conservative methods have failed. At this point in management, having a Physical Medicine Pain Specialist is helpful to best guide treatment tailored to the patient’s needs. Diagnostic imaging of the spine at the level of concern is beneficial to determine an effective management program. Starting with an epidural injection in the region is effective to help lower the overall level of spine sensitivity to pain signals. The next step involves diagnostically blocking the nerves to the joints to confirm the joints are actually causing the pain. If the tests are positive, then the treatment is usually “burning” the nerve, or using radiofrequency neurolysis or ablation. A special needle and machine are used to create a microwave signal along the nerve, severing it from the joint. This is often done with sedation, but is still a quick outpatient procedure. Pain relief will often last about a year, is about 70% successful, and combining this with good conservative care may completely resolve the problem.

Facet Joint Pain of the Low Back – Symptoms and Treatment

July 22, 2013June 24, 2014 / Thomas Cohn, MD

Low back pain can have many causes. Structures in the lumbar region include:

Muscles
Bones
Joints
Discs
Nerves
Pelvic organs

Sensory feedback from these structures can be similar. As a result, determining the cause of low back pain often becomes more complex since multiple areas can produce sensory signals that are perceived the same way. Furthermore, there are often multiple structures contributing to the pain perceptions we have and it may be necessary to treat multiple pain generators to control symptoms.

The facet joints in the spine are small joints the size of our finger joints that articulate on both sides of the spine, posteriorly, between vertebral bodies at every level. They have significant mobility and carry the full body weight. Bending backwards closes the joint, while bending forward tends to open the joint. Since they have the same size and mobility as the finger joints, we can see the same wear and tear type changes in the hands, and assume fairly accurately that the same changes will be present in the low back facet joints.

Symptoms of Facet Joint Pain

The symptoms related to facet joint pain are similar to pain from other joints:

Stiffness after sitting or lying in one position
Pain often with extension of the spine backwards

Pain from facets is often just along the spine and does not radiate significantly into the legs. Often, the lumbar muscles are very tight, trying to prevent excessive spine movement. Severely degenerated facets have significant bony overgrowth, and then can narrow the exit of spinal nerves and cause radiating pain into the leg.

The diagnosis of facet pain is made by:

Patient history
Physical exam
Radiologic imaging
Nerve blocks to the joints

The typical history of facet joint problems is pain along the spine without significant radiation. X-rays and CT scans often show facet problems in detail, but pain can be present even with normal radiologic studies. Diagnostic medial branch blocks are the most reliable tool to establish the etiology of pain from facet joints, and two nerves provide the sensory feedback from each joint.

Treatment

Treatment of facet joint pain must be multifaceted to be successful. Basic level management includes stretching and core strengthening of the lumbar region, with using good body mechanics. Nonsteroidal anti-inflammatory drugs like naproxen and aspirin often are very helpful. More advanced physical therapy including a TENs unit for electrical stimulation and traction of spine is sometimes helpful in addition to the above. For persistent symptoms, facet joint steroid injections and medial branch blocks with radiofrequency denervation of the joint can be extremely beneficial.