Are your facet joints causing you persistent neck pain and/or low back pain?

Chronic severe pain can be debilitating, particularly when the diagnosis is not known. One of the most troublesome categories is neck pain and low back pain. It can render people immobile, making even the simplist activity, like sitting, standing, walking, lifting, driving, and attending to personal care/hygiene as well as household chores, a challenge.  

The spine is an integration of a wide range of  joints, ligaments, muscles as well as the delicate and complex central nervous system. Because of this, surgical treatments targeting neck pain and low back pain can be worrisome due to the risks of such treatments and their potential adverse effects. 

Far too often, the diagnosis and treatment of spinal problems involves expensive tests, risky surgical procedures and powerful drugs with worrisome side effects. It is premature to recommend surgeries and pharmaceutical drugs when there are other options to help remediate chronic pain in the neck and low back.  

If one suffers from relentless neck pain and/or low back pain, it would be wise to seek consultaiton with a formally trained pain management physician who practices alternative, integrative, and interventional medicine.  Step one along the road to problem resolution is problem identification. 

Facet joints serve to connect the bones of the spine and help to guide the spine's motion in flexion, extension, side-bending and rotation.  They're found on both sides of the spinal cord, with each facet joint surface measuring approximately the size of a thumbnail.  If they're injured, or become inflamed due to wear and tear, they can cause muscle pain or severe neck pain and/or low back pain.  This can be difficult to diagnose. A skilled physical examination may be all that's required to diagnose a problem with your facet joints. 

Through spinal manipulation, and without the use of X-rays and MRIs, properly trained specialists can determine the location of the specific facet joint that, due to age or injury, has become the source of pain.  Treatment involves injection of an anesthetic along the facet joint.  This is not an easy task.  It takes a combination of specialized training, sensitive hands, practice, precision and skill. 

Patients can expect a series of visits to the doctor's office for several injections of medication over the course of weeks or months.  One objective is to provide enough pain relief to enable physical therapy to proceed.  Another objective is to determine if the injection alone resolves the pain, or if additional treatments are required. Results depend on the degree of injury, the severity of inflammation, and the effectiveness of physical therapy. 

If the pain cannot be eradicated for long periods by repeated injections, the next step could be a treatment called radiofrequency ablation (RFA). This procedure uses heat generated from radiofrequency energy to destroy nerve function, stopping the nerve from transmitting pain signals to the brain.  RFA uses X-ray guidance, by way of fluoroscopy, to ensure safe and proper position of the needle.

Following RFA treatment, cervical (neck) pain or lumbar (low back) pain may not return.  However, there is always the possibility that the nerve will regenerate after 6-12 months, requiring further RFA treatment. 

Doctors trained in conventional medicine may not direct patients to explore facet joint injection as a potential treatment for back and neck pain.  The common preliminary approach is to order diagnostic imaging studies, such as X-rays, CT scans and MRIs. Expensive tests have a role, but they are just one part of the right answer. Upon obtaining and interpreting proper diagnostic studies, in tandem with proper physical examination, patients should then be informed by their doctors that they have choices not involving pharmacy or surgery. Potent painkillers by prescription should be the last resort, not the first, as they can have many negative effects and can cause physical dependence and even addiction. When considering neck or back surgery, nothing can be guaranteed when agreeing to surgery.

Many people suffer through neck pain and low back pain without resolution.  It may be time to ask your doctor for more information.  

Philip G. Khoury, D.O.