Make Pain a Thing of the Past – facet – Physician Partners of America

Tag Archive for: facet

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.

 

Interviewer: We see ads all the time for magic creams and patches for pain relief. There are so many ways that claim to treat pain, between pills, patches, injections, lotions. So how do we know what actually works? Dr. Rudy Gary from Florida Pain Relief Group joins us now to help us figure it all out. Dr. Gary, welcome back.

Dr. Gary: Thank you.

Interviewer: Now, how do we know if these things really work?

Dr. Gary: Well, the best answer to that is to find out exactly what that is. You know, you hear it on the radio, you know, these cure-alls.

Interviewer: Yeah, call now.

Dr. Gary: Yeah, unfortunately, sometimes some of those are just kind of like a placebo effect. You know, it may be just aspirin could be in there. Is it gonna help? Yeah, it’s going to help you. We can probably just give you just about any patch, and one-third of the patients are going to react positively. The problem is it doesn’t last long.

Interviewer: Right.

Dr. Gary: What we have to do is you have to go see a real physician, somebody what went to medical school, studied anatomy and physiology, pharmacology, and is going to establish a diagnosis on you, is going to treat you as a patient, is going to listen to what is wrong with you, actually perform a physical examination, laboratory examinations, radiology, find out what the problem is, make a determination of how that affects you, and then get a plan in place, whether it’s a pill, a patch, an injection, whatever it may be, and target that area.

Interviewer: Well, let’s talk about some of those options out there, because what would be the best way to alleviate pain? Would it be a pill, would it be a patch, an injection, a cream? I mean, there are so many choices?

Dr. Gary: So the answer is it depends.

Interviewer: Yeah.

Dr. Gary: Right? So it depends on number one, who the patient is. It depends on what the problem is. Sometimes, we can eliminate the pain with a simple injection, that’s what we take and your pain is gone. Other times, that’s not the best way and we’re going to try out some very low-level analgesics. Maybe like a muscle-relaxant, you know you might be having spasms. We’re going to determine the type of pain. So there are actually different types of pain. There is what’s called neuropathic pain which is a nerve pain, and there is something else that’s called nociceptive pain, which is more like a dull achy pain. And the medication and the treatment depends on the type of pain that it is. It’s coming from your nerves, your joints, some of the organs, and we have to target, and the physician that’s very keen to that type is going to give you much better results.

Interviewer: We’ve heard of those icy patches that you can buy at the pharmacy, and I’m wondering, do they work? There’s hot patches, cold patches.

Dr. Gary: Well, they work to the extent that… There was actually someone that won the Nobel prize for that, it’s called the gate theory. And what that does is that works about as good as… So if you’re…you may recall when you were little and you put your finger on the stove and boy that really hurts. So what does mom do? Mom comes by and she rubs your finger, and the pain is better. Well, the reason why the pain is better is because what you feel is the rubbing sensation and that blocks the pain sensation. So whether the ice packs, heat packs, you’re going to feel the heat or the cold instead of the pain.

Interviewer: Right.

Dr. Gary: It does work, so does massage and a lot of different things.

Interviewer: It’s a distraction more than anything.

Dr. Gary: Yeah, because again, it’s called the gate theory of pain.

Interviewer: Right.

Dr. Gary: So only a certain type of fiber can go to your brain for you to understand that, and then it will block the other sensation.

Interviewer: Okay.

Dr. Gary: We actually have a procedure called [inaudible 00:03:26] stimulation. And what that does is that people that are having severe low back pain, pain shooting down the legs, have had three or four back operations, we can put these tiny little electrodes so you feel a tingling sensation instead of this pain that you have. And you can control that in programming.

Interviewer: Oh, I’m sure a lot of people are happy to hear about that. Dr. Gary, thank you very much. Florida Pain Relief Group even schedules same day appointments. We’ll be back with more daytime, so don’t go away.

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.