Facet Joint Pain

Facet joint pain is a condition that is caused by a pinched nerve or lack of synovium joint fluid at the facet joints, which are pairs of joints that connect the vertebrae. Also known as facet joint syndrome, this condition typically affects the elderly due to to age-related joint changes but can occur in young individuals who have experienced spinal trauma.

Features

Facet joint pain, also known as facet joint syndrome, refers to pain stemming from the facet joints, which are pairs of joints at the back of each vertebra. Individuals who are affected by this syndrome typically begin experiencing lower back and neck pain. The lower back pain may later travel to the thigh and buttocks, while the neck pain can later spread to the shoulders or lead to headaches.

The back pain associated with this condition can cause stiffness with certain movements, difficulty standing straight or getting out of a chair. When symptoms are related to neck pain, one may have difficulty turning his head.

Function

The role of the facet joints is to vertically connect all of the vertebrae so that the spine can operate as a single unit and engage in weight-bearing activities. Like other joints, such as the hips and knees, the facet joints are covered with synovium fluid and cartilage. The synovium fluid contained in joint capsules allows for bone movement with minimal friction. A lack of this fluid results in the inability to move bones and can further result in arthritis.

Causes

Due to the functional role of facet joints, they are constantly in motion and have undergone significant mechanical stress by the time one reaches his fiftieth birthday. In the elderly, facet joint pain is caused by the degeneration of synovium fluid, which can lead to arthritis. Additionally, injuries and/or trauma contribute to the wear and tear of these joints, which can cause facet joint syndrome. Injuries can reduce cartilage, which leads to an inflammation that causes pain.

Diagnosis

Diagnosis of facet joint syndrome can only be done with a physical exam and review of a patient's medical history. Imaging procedures, such as an MRI, CT scan or X-ray, may be needed if other spinal conditions, such as a fractured or herniated disc, are suspect.

Once all other conditions that may be causing the pain are ruled out, a patient may need to undergo a facet joint block procedure to confirm a facet pain syndrome diagnosis. This involves anesthesia being injected to the location of the pain. Because this procedure numbs the nerves of the facet joints, if the pain is indeed caused by facet joint-specific issues, this procedure should significantly alleviate patient's pain.

Prevention/Solution

Similar to treatments for other skeletal and skeletal-muscle conditions, facet joint syndrome treatment involves the need to alleviate the pain and encourage proper muscle movement to correct or slow down the progression of the underlying joint issues. As a result, the standard solution is a combination of treatments. These treatments entail physical therapy, chiropractic procedures and/or medication.

Patients diagnosed with facet joint syndrome may be prescribed a over-the-counter or prescription non-steroidal anti-inflammatory drug (NSAID) to reduce inflammation and muscle spasms, thereby alleviating the pain. Typically, chiropractic sessions and/or physical therapy are prescribed in combination with the NSAID.

The purpose of chiropractic procedures and physical therapy is to correct posture, keep the spine in alignment and to learn or relearn proper muscle movement. All of the above will play a role in reducing inflammation and pain. Regular exercise also needs to be maintained after physical therapy in order to continue increasing flexibility and strength, while improving circulation.

If a patient continues to be in pain and sees no long-term improvements following NSAID treatment in combination with chiropractic procedures and/or physical therapy, surgery is an option. The most common procedure is rhizotomy, which involves killing some of the nerves that cause the facet pain. However, individuals should only opt for invasive procedures when all non-invasive treatments have failed.

References

• Facet joint syndrome information
• About facet joint pain
• Clinical management of chronic spinal pain