Lumbar facet arthropathy

Axial low back pain is often due to arthritic pain of spine facet joints, which sustain wear-and-tear from daily activities. The joints can hurt and cause pain across the low back. Ablating the small “medial branch nerve endings” to the facets can help kick-start recovery.

Axial low back pain

Axial low back pain — involving only the back only and does not go down the leg — is the most common pain issue at primary care clinic visits.

For patients who have not had back surgery or back injury, the most likely explanation is pain coming from the lumbar facets.

Facet joints

As joints, lumbar facets experience normal wear-and-tear through their activities. When the facets become painful, it often triggers a cascading series of changes (“the chronic pain cycle”) that amplify pain experience:

  • Reflex guarding is a spinal cord reflex causing back muscle spasms
  • Biomechanical alterations in movement cause additional pain
  • Reduction in activities by the patient invariably causes more back pain. This “fear of movement” can become more problematic than the facet pain itself.

Symptoms

  • Axial back pain
  • Morning back stiffness
  • Back pain worse with bending backwards & twisting

Diagnosis

  • Physical examination
  • X-ray, CT, and/or MRI of the lumbar spine
  • Rule out other conditions such as sacroiliac joint dysfunction, referred hip pain pain, spondylolisthesis
  • Rule out other “red flag” medical conditions

Treatment

  • Physical therapy strengthening the core muscles can reduce stress on the facet joints — “motion is lotion”.
  • Aquatherapy performed in warm pools can be helpful by allowing exercises with less load on the back.
  • Nerve ablation of “medial branch” nerve endings can provide months of relief and enable more thorough physical therapy. This is completed in 2 stages: Stage 1 diagnostic block(s), which if positive is followed by Stage 2 nerve ablation.
  • Peripheral nerve stimulation (PNS) & spinal cord stimulation (SCS) for non-drug, convenient therapy.
  • Comprehensive pain management including pain psychology, physical therapy, and complementary & alternative medicine (CAM)

Back Pain

Dr. Ming Kao View All →

Pain physician & PhD computational biologist @StanfordPain • Advanced pain interventions with CIPS & FIPP • Opinions mine & not medical advice

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