16th November 2006 at 19:17 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.
Article on the symptoms and signs of lower back pain caused by facet joint irritation and its treatment by facet joint injection
Facet joints are defined as the small joints located in pairs at each segment on the posterior or back of the spine. These joints are a little larger than the size of the thumb nails and provide stability and guide motion in the lower back.
The joints are made up of the two surfaces of adjacent vertebrae, separated by a thin layer of cartilage. It is surrounded by a sac-like capsule filled with the synovial fluid, a lubricating liquid that reduces the friction between the two bone surfaces when the spine moves.
The most common symptoms of facet joint pain from the lower back include:
· Pain or tenderness in the lower back over to one or both sides
· Pain with lower back extension
· Pain with twisting
· Radiation of pain to the buttocks or back of thighs.
In a facet joint injection, a steroid medication is injected in order to anesthetize the facet joints and block the pain.
A facet joint injection is administered to accomplish one of the two goals listed below:
The first reason for a facet joint injection to be used is to ascertain whether the joint is truly the source of back pain. A numbing medicine is placed into the joint, due to which the patient might experience immediate pain relief, while the joints remain numb.
If this happens, it confirms that the joints in question are actually the source of pain.
ii) Therapeutic: Therapeutic injections of time-release cortisone are given in to the facet joints to reduce inflammation, which often provides long-term relief from pain. This procedure is also referred to as a facet block .i.e. having the purpose of blocking the pain.
Another major purpose of a facet joint injection is to provide temporary pain relief with the numbing medicine, enabling the chiropractor or physical therapist to treat the pain effectively.
The procedure for administering a facet joint injection normally follows the below steps:
1) The patient is made to lie on his stomach on an X-ray table. At times, a fluoroscopic X-ray is done to help ascertain the correct position for the fine needle.
2) The lower back is sterilely cleansed with povidone-iodine and alcohol.
3) A needle is gently positioned into the facet joint, causing mild pain.
4) A small amount of water-soluble contrast or a dye is injected to confirm the accuracy of needle insertion.
5) Upon confirmation, a mixture of anesthetic (lidocaine or bupivacaine) and anti-inflammatory medication or steroids is injected.
6) The needle is then slowly withdrawn from the point.
A number of studies and research reports evaluate the effectiveness of facet injections as a diagnostic and therapeutic tool for lower back pain.
Research largely indicates that facet joint injections can give relief from lower back pain for longer than six months in more than 60% of patients who take the treatment.
It is also recommended that facet joint injections should be used primarily as a method to allow the patient to take other forms of conservative treatment, including physical exercise, yoga, stretching or bending, rather than being administered as a stand-alone pain treatment.
© London Pain Clinic 2006.
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