Spinal Joint Injections Help Doctors Pinpoint Source of Pain

Back PainEpidural Injection

Injections of analgesic and steroidal medications may provide only temporary relief from neck and back pain, but they have become a cornerstone to correctly diagnosing a disorder called facet joint syndrome and developing longer-term solutions to the problem, says Interventional Pain Management Specialist Dr. Jason Arora with Atlantic Spine Center.

“The source of pain in a patient’s neck or back, especially in the lumbar (lower) back, is often difficult to pinpoint, preventing the spinal surgeon or physician from reliably taking next steps to resolve it. But should an injection of anesthetic or anti-inflammatory drugs into the lumbar, thoracic, or cervical facets give the patient almost immediate relief, the physician is able to confirm location of a patient’s pain and determine whether the patient is likely suffering from compromised facet joints. The physician can then proceed with longer-lasting non-surgical or minimally invasive therapies, such as radiofrequency ablation,” Dr. Arora says.

Studies support Dr. Arora’s comments. Authors of research published in Insights Imaging indicate facet joint syndrome is a “misunderstood, misdiagnosed, and improperly treated pathology” and cite the “ability of facet joint pathology to mimic spine root compression, the low specificity [and sensitivity] of facet joint syndrome, and inefficient use of lumbar imaging.” They add that “diagnostic blocks are a keystone of facet syndrome diagnosis. If diagnostic blocks of the nerves that supply specific facet joints relieve the patient’s pain, denervation procedure [ablation] of the same nerves can be offered to provide prolonged benefit [to the patient].” Otherwise, “there are no effective correlations between clinical symptoms and degenerative spinal changes.”

Dr. Arora cautions, however, that facet-joint injections, even though they are low risk, should only be performed when more conservative measures. For example, if the use of an anti-inflammatory, non-steroidal medications taken orally; physical therapy; posture corrections; and modifications in a person’s activities, have failed to bring the patient relief and pain becomes chronic.

Facet joint syndrome is considered an underlying cause of nearly half the cases of chronic lumbar pain, a leading medical complaint worldwide and a major socioeconomic burden. Experts contend that up to 67 percent of cases of neck pain, 48 percent of thoracic pain, and 45 percent of lumbar pain are the result of diseased facet joints, Dr. Arora relates.

The facet joints are surrounded by capsules rich in nerve supply. The joints function like hinges, giving the spine its flexibility and stability, allowing the back and neck to move forward, backwards, and rotationally. Two facets are connected and paired with each vertebra; the intervertebral discs serve as spacers for the facets.

Facet joint syndrome causes chronic, often debilitating, pain and can occur almost anywhere along the spine due to joint-related trauma, like whiplash; segmental instability; inflammation of the joint lining; and other disorders. But the syndrome is most commonly caused by deterioration and malalignment of facet structure in the lower back, brought on by the ravages of aging, including development of osteoarthritis. In fact, facet joint deterioration is frequently detected in the medical images of both older individuals with pain and those who are asymptomatic.

“Not surprising that joints and discs in the lumbar area are highly susceptible to degeneration. The lumbar spine bears the bulk of weight and experiences the most strain during a person’s lifetime,” Dr. Arora says.

Facet joint injections usually involve administration of analgesics, sometimes in combination with an anti-inflammatory drug or corticosteroids, directly (intra-articular) into the inflamed facet joint. The injection reduces sensitivity of pain receptors and helps minimize production of inflammatory biochemicals; its effects may endure as long as a month, but it is not considered a procedure with significant therapeutic utility, Dr. Arora explains.

If facet joint syndrome is confirmed by intra-articular injection, the specialist may proceed with performing a medial branch block in which a pharmaceutical is delivered to the joint capsule -- an area around the facet joint -- to calm nerve activity, provide pain relief, and improve spine motion. Medial branch blocks have longer lasting effects but have to be repeated -- up to three times a year.

Other interventional treatment approaches for the facet syndrome include using the heat of radiofrequency waves, cryoneurolysis (cold therapy), or chemicals to denervate (cut off, destroy) nerve fibers, quell pain, and reduce disability.

Although no one can stop the aging process, Dr. Arora offers easy-to-follow tips for keeping the spine healthy:

  • Do low-impact exercises regularly – like walking, biking, or swimming – to keep joints working and minimize development of joint pain and stiffness. The adage for cars also applies to people: move or rust.
  • Pay attention to posture and body mechanics. That means sit with back straight in a chair – no slouching, limit the amount of time sitting, and avoid activities that put too much stress on joints, especially the spine.
  • Follow a healthy eating plan that is replete with foods known to have anti-inflammatory properties and that are rich in nutrients like calcium and vitamin D. Check out the Mediterranean diet for examples of what constitutes nutritious foods.
  • Consult with a physician or exercise physiologist about activities that can enhance back and abdominal muscles. Strong core (trunk) muscles provide important support to the spine.
  • Keep weight to what is appropriate for one’s height, use proper techniques when lifting, and stop smoking. “Remember, your lifestyle has a lot to say about whether eventually you will develop spinal problems,” Dr. Arora says.