Your Pain Stops Here!
(602) 507-6550 Of the millions of chronic back pain sufferers in America, just less than half (45%) have the facet joints as their pain generator. This is termed facet joint syndrome. Facet joint injections are the most common interventional pain management procedure by far in the US. They work well about 80% of the time.
Making the diagnosis of facet joint syndrome is difficult with simply a history, physical examination, and imaging studies. Similar to arthritis seen in other body joints like the knee and hip, the presence of arthritis does not mean the patient will have pain. Endstage degenerative arthritis may be present with the patient experiencing minimal pain.
The best method available for determining whether or not a patient has facet joint syndrome is a diagnostic injection into the joint. This injection is when a pain doctor performs a diagnostic injection of numbing medicine around the facet joint to numb up the small nerve endings supplying sensation to the joint (and pain). If the patient’s pain is substantially relieved from the numbing injection, then the diagnosis of facet joint syndrome is cemented.
Facet joint intra-articular injections and medial branch blocks have been shown to provide on average five to seven months of pain relief. When the pain wears off, the injections can be repeated with similarly successful results.
In the 1970′s and 80′s, radiofrequency denervation was developed for the first time and modified as it became more successful. It has grown in popularity as clinical research studies have shown very good outcomes with the procedure.
Radiofrequency ablation involves putting a catheter in the same area as where a medial branch block is performed. Rather than injecting the numbing medicine at that point, the tip of the catheter is heated with radiofrequency waves and the tiny little nerve endings are deadened.
Results of studies that have been done looking at radiofrequency neurotomy have been encouraging. Good to excellent results after RF procedures have been 70-90% for a year with pain being relieved for up to 2 years. This is much longer than facet joint injections. Eventually the medial branches that were deadened will regenerate and the pain may return. At that point the procedure may successfully be repeated. The RF procedure may allow patients to decrease their pain medication needs substantially.
It should be noted that patients may temporarily see increased pain after a radiofrequency ablation. This may be due to muscle spasms from the procedure. Typically within a week the pain relief will begin and the benefits will be noticed.
RF procedures are performed in an outpatient setting. They can be done under local numbing and/or IV sedation. The procedure is predominantly safe with a low risk profile, but there are potential complications. Those include dural puncture, spinal cord trauma, infection, painful dysethesias/hyperesthesia, or increased pain.
David L. Greene, MD, Phoenix, AZ is CEO of Preferred Pain Center which serves the Phoenix and Scottsdale, AZ metropolitan and surrounding areas. He can be reached at dgreene@preferredpaincenter.com and (602) 507-6550.
Preferred Pain Center is a Comprehensive Pain Center including Medical and Interventional Arizona Pain Doctors, Phoenix Chiropractors Treatment, Phoenix Physical Therapy, Spinal Decompression Therapy, and Manipulation Under Anesthesia.
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.
How often is chronic low back pain coming from facet arthritis or injury? Somewhere between 30 and 40%, according to the literature.
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 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 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 recent study in Pain Physician Journal 2009 showed that if the 80% criteria is used, at 2 years time 90% of individuals still continued to have a diagnosis of facet joint pain. With the 50% criteria establishing facet pain, the same study showed only a 51% maintenance of facet joint pain as a diagnosis.
How well do facet joint nerve blocks work? A number of studies have looked at the effectiveness of injections into and around the facet joints. Unfortunately, most of the studies have been small and/or not randomized. This does not mean the results are invalid, rather, the level of evidence is not as strong as what a larger study would bring.
Results for facet joint nerve blocks (medial branch blocks) have been positive, with an average of 80% pain relief lasting between five and seven months. Studies have also shown beneficial results that when the pain relief wears off, repeat injections work well, or the patient can undergo a radiofrequency neurotomy. Patients noted substantial improvements in overall health status, return to work status, functional, 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.
Preferred Pain Center’s doctors do wonders with low back injections and nonoperative treatments. Call TODAY for assistance at (602) 507-6550. We also offer PT, Rehab, chiropractic, acupuncture, medications, spinal decompression, and manipulation under anesthesia.
