The joints of the spine are referred to as the facet joints. The facet joints were once considered a primary source of back pain and sciatica in that irritation of the facet joint could result in associated leg pain. This early research led to the use of direct injection therapy into the facet joint to treat both sciatica and low back pain.
Over time, however, the use of facet joint injections to treat back pain and sciatica has been the subject of much controversy. In this article, we look at the pros and cons of facet joint injections to treat back pain.
Lumbar Facet Joint Injection Information
Dr Paul Dreyfuss, a physiatrist at Washington Interventional Spine Associates in Bellevue, WA. and contributing author at Spine Universe, describes the facet joint injection procedure.
What are lumbar facet joints?
Lumbar facet joints are small joints located in pairs in your lower back. These joints provide stability and guide motion in your spine.
Why are facet joint injections helpful?
If the joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The lumbar facet joints can cause pain in your lower back, hip, buttock, or leg.
A facet joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the facet joints are numb, then these joints are likely your pain source. Furthermore, time-release cortisone will be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.
What will happen to me during the procedure?
An IV will be started so that adequate relaxation medicine can be given, if needed. After lying on an x-ray table, the skin over the area of the spine to be treated will be well cleansed. Next, the physician numbs a small area of skin with numbing medicine (anesthetic), which stings for a few seconds. Next, the physician will use x-ray guidance to direct a very small needle into the joint. He then injects several drops of contrast dye to confirm that the medicine only goes into the joint. A small mixture of numbing medicine (anesthetic) and anti-inflammatory cortisone is then slowly injected. (Read full article here)
Facet Joint Injection Controversy
In their Health Blog, the Wall Street Journal reports…
With explosive growth in the use of interventional techniques to treat chronic pain, the American Society of Anesthesiologists has updated its circa-1996 guidelines to help doctors and patients sort through the dizzying array of new options, today’s Informed Patient column reports.
But some of the techniques — which include implantable devices to stimulate nerves and injections to numb them — are controversial, and questions remain about the appropriateness of their use, according to several studies in the current issue of Pain Physician, a medical journal. (Read full article)
Clinical Results For Facet Joint Injections Are Mixed
As reported in Pain Physician, the effectiveness of facet joint injections for the treatment of back pain varies.
Background: Facet joint interventions are used frequently for managing chronic spinal pain. Evidence continues to accumulate supporting the clinical effectiveness of these procedures and defining potential complications.
Objective: To evaluate the effectiveness of three types of facet joint interventions (facet joint injections, medial branch blocks and facet joint neurotomy) in managing spinal pain.
Study Design: A systematic review utilizing the criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and Cochrane Musculoskeletal Review Group for randomized trials.
Methods: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (January 1966 to November 2004), manual searches of bibliographies of known primary and review articles, and abstracts from scientific meetings within the last 2 years.
Analyses were performed for the different modes of facet joint interventions of cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with the procedures.
Outcome Measures: The primary outcome measure was pain relief. For facet joint injections and medial branch blocks, short-term pain relief was defined as relief less than 6 weeks, and long-term as 6 weeks or longer. For medial branch radiofrequency neurotomy, short-term relief was defined as pain relief of less than 3 months, and long-term as 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work.
Results: For lumbar intraarticular facet joint injections, there was moderate evidence for short-term improvement, and limited evidence for long-term improvement. The evidence was negative for cervical intraarticular facet joint injections.
For cervical and lumbar medial branch blocks with local anesthetics and steroids, the evidence was moderate.
(Read full article here)
And from the Journal of Bone and Joint Surgery…
FACET JOINT INJECTIONS: DO THEY WORK?
T. Taneja; C. Critchley; A. Bhadra; A. Sivaraman; and C. Natali Royal London Hospital, 79 Woodland Grove, Epping, Essex, Epping, CM16 4NF UK
Backpain is a common cause of patient referral to pain clinics. Around 120 000 patients with back pain are seen in UK Pain Clinics every year. Facet joint injections are a commonly used treatment modality.
However there is considerable controversy regarding their efficacy. Most of the evidence supporting the use of injections is anecdotal, rather than being based on randomised studies.
We carried out a prospective study to assess the efficacy of facet joint injections in relieving chronic low back pain. Our study group comprised 41 patients (57% females, 43% males). Patients completed the Oswestry Disability Index (ODI) and marked their pain levels on a Visual Analogue Scale (1 to 10). (Read full article)
Do you have a question about facet joint injections or some other form of pain management to resolve your back pain, neck pain, or sciatica? We have specific Patient Guides that discuss specific pain management techniques in detail, including facet joint injections. If you would like access to these informative and easy to understand Patient Guides, just click this link and we’ll make sure you get your copy today. Patients’ Guide To Facet Joint Injections
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