Back pain afflicts ninety percent of Americans at some point. The vast majority of back pain, 90%, will resolve within six to twelve weeks regardless of the treatment. What about the other ten percent?
If the back pain is being generated from facet arthritis, also called facet syndrome, the back pain can become chronic and be extremely disabling to patients. It can wax and wane or remain present like a pebble in a person’s shoe. The main issue with arthritis is there is no treatment available which can reverse it. One can only hope to try and contain it with pain relief options that alleviate the symptoms, such as facet injections.
Facet joints allow the spine to move in a lot of directions and connect the spinal bones. The lumbar spine is located in the low back and contains 5 vertebrae.
Each is roughly the size of a thumbnail. Lumbar facet joints are named for the spinal vertebrae they connect and the side they are found on the spine. The right L4-5 joint, for example, joins the 4th and 5th lumbar vertebrae on the right side.
In most patients, pain emanating from the facet joints causes back pain and does not go into the legs. This pain may be coming from cartilage injury inside the joint or from a ligament injury surrounding the joints. This could be from degenerative arthritis or from a post traumatic injury. Pain coming from an injured joint can be coming from simple muscle tension or from more severe disabling pain.
Common tests such as MRI’s or radiographs may not display the joint as being the cause of pain.
One of the treatment options for low back pain from facet arthritis is injections, also known as facet blocks. Pain doctors perform the blocks commonly for back pain from facet syndrome. Facet blocks can give pain relief for weeks to months, and are performed as an outpatient procedure.
Facet injections are done with appropriate numbing medication. The blocks can be both therapeutic and diagnostic for neck or back pain. A facet joint injection can denote whether the joints are the source of pain and can help alleviate the pain and inflammation.
An immediate x-ray called fluoroscopy allows for accurate needle placement in the facet joint and then dye is often placed to make sure it’s in the correct joint.
Once proper needle placement is assured, the physician injects numbing solution in addition to a corticosteroid. After a day when the numbing medicine wears off, the steroid medication kicks in. Pain relief may last for weeks to months, or maybe not at all. Pain relief that does happen suggests that the facet joint was the cause of the pain.
Pain relief occurs in three to ten days as the steroid medication reduces inflammation. As many as three injections per year may be given per facet joint.