Facet Joint Injections for the Treatment of Chronic Low Back Pain
Chronic low back pain in the US is a substantial problem, with 90% of Americans dealing with back pain at some point in time. Considering that 90% of that pain goes away within 6 to 12 weeks, that means at any one point in time that 10% of the US is dealing with chronic low back pain.
What is the percent of chronic back pain coming from facet arthritis or injury? According to the literature, it’s somewhere between thirty and forty percent.
When diagnosing the source of the pain, a definitive answer can be elusive. History, physical examination, and imaging studies are often helpful, however, an exact pain generator is not always established. And when it is established, it is often only partially correct or just plain wrong.
Diagnostic injections, called blocks, are often performed of the facet joint or its nerve supply to establish facet joint pain. If the joint is a source of pain, then numbing it should decrease the pain being felt. If it is not, the pain number described shouldn’t change. How accurate are these diagnostic injections?
It used to be acceptable for patients to achieve 50% pain relief from diagnostic facet joint or nerve supply injections. However, numerous studies have shown that there is considerably more reliability in the diagnosis if the patient receives 80% pain relief. Some insurance companies require 80% pain relief on 2 separate occasions prior to approving a radiofrequency ablation.
One study from Pain Physician Journal recently showed that with the 80% criteria being used, after 2 years ninety percent of people maintained the same diagnosis of facet joint pain. Using 50% criteria, only half of the patients maintained facet joint syndrome as a diagnosis.
How well do these blocks work? A number of studies have looked at the effectiveness of the injections around and into the facet joints. Unfortunately, most of the research involved smaller or non-randomized studies. This doesn’t invalidate the results, it just means that the level of evidence is less than a very large research project.
Results for facet joint nerve injections (termed medial branch blocks) have been very good, averaging eighty percent pain relief helping patients between 5 and 7 months. Research has also shown satisfactory results for when the pain comes back, repeating the injections or the patient may undergo a radiofrequency neurotomy. Patients have seen significant improvement in returning to work, function, general health status, and psychological status.
Compared with low back surgery, facet joint nerve blocks are an extremely cost effective, low risk option for pain relief that work.
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