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Facet Joint treatment

Started by kerryjess on 03/07/2010 11:10am

Hi. I am new to the site and have suffered back problems for over 20 years. I have bulging discs at L3/4, L4/5 and the sacroiliac joint has a tendency to twist. I manage the pain with painkillers, anti-inflammatories, physiotherapy, acupuncture and bed rest when necessary. I have had epidurals for the pain, but not for a few years. I suffer regular bouts of sciatica and have problems with my knee and ankle tendons, all on the right side.
I was referred again to a different Pain Clinic and have been told I have Facet Joint Syndrome. The doctor has recommended Radio Frequency treatment, as I seem to have tried everything else.
Q. If anyone has had this treatment, what relief have you experienced (if any!) and how long were you relatively pain free?
Q. Has anyone experienced problems connected with this procedure?

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I have now had two of these treatments. In both cases, pain management insisted on doing a temporary diagnostic block. I kept a pain diary and tried to do as many activities that usually cause pain as possible in a short time. If you get any relief (diagnostic blocks last 8 hours at most), then it is a go for the radioablation. The first time I had great results for 2-3 years until the nerves started to grow back. Now have just had a second one and my pain is 90% gone. However, I am aware the underlying cause of my pain (severe facet joint arthritis with associated with grade 1-2 slippage) is not being cured so I have to be careful to continue all the PT exercises to strengthen abdominal muscles.
Eventually the problem may become sufficiently severe that covering up the pain will not be enough (if neurological problems develop) and I will need a fusion. However, for the time being I have my life back.

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Greetings:

I've had lower back pain for about 6 yrs. now between L4 &L5. left side only, never on the right.

Quite by accident I found out about Pain Management Dr.s. I had my first lumbar epidural steroid injection in early Feb. 2010 with a follow-up two weeks later. I explained to my PM Dr. that the pain in that area was somewhat better but not what I had hoped for.

On 3/8/2010 I had a second injection called Lumbar Facet Joint Block which was different than the first. So far I'm on day four and the lower back pain that I would ordinarily experience within the first 10 minutes of getting up is gone. FYI - this second multiple injection is time-released so it can take several days/weeks to do its job. Go to lumbar facet joint block and read about it. There's also an animated short video as well. Hope this info. helps anyone out there. Today is a great pain free one so far thanks to PM!

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I did not recieve pain relief from the facet joint injections, however I imediately had gained full flexability and motion again in my lower back. After 8months I still have most of my mobility. The radiofrequency treatments helped to diminish my pain to a tolerable level. Bear in mind I have a very strenous and physical occupation heavy lifting, bending..... My point being if your less active I could see them working well, but no to bodies are the same. Radiofrequency treatment relieved pain for 8months.

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It is clear that there is considerable confusion on this subject. I think it is time that Spineuniverse did an update on the information. It should include clear explanations of the differences between injections into the facet joints to relieve inflammation (steroid injections), diagnostic nerve blocks, and radiofrequency ablation (more or less permanent nerve blocks). It would be great if some of the studies on the efficacy of the various treatments were included as I know there is some disagreement.
Most of us (myself included) have more than one anatomical back abnormality and it is not surprising to me that there is a lot of difference in the outcome from a single type of treatment. It is also important to emphasize that these treatments are for PAIN relief and do not correct the underlying problem. I would love to hear what criteria should be used to decide when even more invasive procedures are warranted. My MRI report says that I have slippage of one vertebrae on the other consequent to the facet joint problems worsening with time --now nearly Grade 2. My question is how bad does this have to get before a fusion surgery is warranted?

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Dear Kerri,

I have had severe back pain for about 20 years. I have arthritis of my facet joints, a bulging disc in the neck and lumbar spine, and the pain has been getting progressively worse over the years. I used to be treated by a rheumatologist (who diagnosed the fibromyalgia), who eventually referred me to a physiatrist (pain and physical medicine physician), when trigger point injections no longer worked. We started with epidural steroid injections, which worked for a while. Then the pain was getting so severe that I was ready for an implantable morphine pump or implantable e-stim unit. Fortunately, my doctor had other ideas. We then started with phenol injections into the facet joints - phenol will kill the peripheral nerves in the joints. Unfortunately, the positive effects are only temporary, but I received relief for 9 months. Eventually the phenol injections stopped working and we moved to radiofrequency ablation. Again, this effects the peripheral nerves within the facet joints - these nerves DO grow back, but it takes a while. My last treatment was over a year ago, and the pain is starting to come back. I should be getting a new treatment shortly. I would highly recommend this procedure, even if it means going through a nerve block ( relief time 8-10 hours) to determine if the procedure will work for you. I would use a physiatrist instead of an anesthesiologist if you have one in your insurance plan that does these procedures (many do not, and I have been worked on by an anesthesiologist - same result.

I am disabled due to this back pain, primarily because I am wired for reacting badly to stress, and have yet to find a relatively stress-free job. Since I have stopped working, pain levels in general are much better. Some of this is from Cymbalta, which I take for fibromyalgia. Given your pain levels, I would also consult a rheumatologist to rule out fibromyalgia. It makes "normal" pain levels muich, much worse.

I hope this helps, and best of luck to you!

Pam

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