Facet Joints Pain – Causes, Symptoms, Treatment

Facet Joints Pain (FA) is a degenerative painful, synovial joint arthritic condition of the facet joints. These joints allow for bending, twisting, and alignment of the spine. The spinal nerves come off the spinal cord between the vertebra and the facet joints. At the front, the vertebra rests on a spongy contained disc while at the back each of the two facet joints rests over the facet joint below it. In a healthy spine, the spinal disc and the facet joints support each other for healthy and safe movement.

Facet joint arthrosis is a degenerative syndrome that typically occurs secondary to age, obesity, poor body mechanics, repetitive overuse, and microtrauma. Numerous studies have linked facet joint degeneration to degeneration of intervertebral disks, showing that intervertebral disk degeneration likely occurs before facet joint arthrosis.

Causes of Facet Joints Pain

Facet arthropathy happens when the cartilage between the facet joints breaks down or gets damaged. This may be caused by:

  • Osteoarthritis – This degenerative disease is a result of the wearing down of cartilage in the joints. Although it is most common in the hips and knees, it can affect any joint, including the facet joints.
  • Accidents or injuries – A car accident, sports injury, or a fall can damage one or more of the facet joints, leading to facet arthropathy.
  • Wear and tear on the facet joints – Heavy lifting, improper posture, and disc problems are some of the factors that can cause the cartilage to wear down.

Facet arthritis may be manifested like other musculoskeletal disorders. Examples of differential diagnoses include

  • Herniated disc with impingement of the nerve roots
  • Discogenic pain syndrome including internal rupture of the disc
  • Radiculopathy
  • Trunk muscles and ligament sprain/strain injuries
  • Spondylolysis/spondylolisthesis
  • Piriformis syndrome
  • Sacroiliac joint injury
  • Entrapment of superior cluneal nerve
  • Thoracolumbar fascia dysfunction
  • Inflammatory arthritis of the spine from rheumatoid arthritis or ankylosis spondylosis
  • Spinal infection
  • Neoplasm of the spine

Symptoms of Facet Joints Pain

Symptoms of facet arthropathy include:

  • Pain: The most common and noticeable symptom of facet arthropathy is pain. Features of pain caused by facet arthropathy include:
  • Pain that is worse following sleep or rest
  • Lower back pain that worsens when twisting, bending backward, and standing
  • Back pain that worsens with lifting objects or twisting the body
  • Pain in the neck or back that aggravates with bending or leaning backward
  • Stiffness or inability to move part of the neck or back
  • Pain centered to one specific area of the spine
  • A dull ache on one or both sides of the lower back
  • Unlike the pain caused by sciatica, or a slipped disc, facet arthropathy pain doesn’t typically extend down the legs
  • Development of other conditions including bone spurs, and spinal stenosis.

Diagnosis of Facet Joints Pain

A complete medical history and physical exam can usually identify any serious conditions that may be causing the painful facet joints arthropathy. Neurologic tests can help determine the cause of pain and appropriate treatment.

Lab Test and Imaging

  • Blood tests – CBC, ESR, HB are routinely used to diagnose the cause of back pain facet joints arthropathy but might be ordered to look for signs of inflammation, infection, cancer, facet joints arthropathy, and/or arthritis.
  • Bone scans – can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as measure levels of joint disease.
  • Discography – involves injecting a contrast dye into a spinal disc thought to be causing low back pain and facet joints arthropathy. The fluid pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.

Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include

  • electromyography (EMG) – assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles in the backside. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body.
  • evoked potential studies – involve two sets of electrodes one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
  • nerve conduction studies (NCS) – also use two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage.
  • Computerized tomography (CT) – can show soft tissue structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.
  • Magnetic resonance imaging (MRI) – creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected
  • X-ray imaging can show broken bones or an injured or misaligned vertebra.
  • Myelograms – enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scan.

Treatment of Facet Joints Pain

Non-pharmacological

The American College of Physicians Clinical Guidelines Committee (ACPCGC) guideline helps. The ACP recommends superficial heat, massage, acupuncture, or spinal manipulation as first-line therapy

  • Maintaining a healthy body weight – Being overweight increases the risk of osteoarthritis and facet arthropathy.
  • Exercising regularly – Walking, swimming, and other low-impact activities are easy on the joints and can help keep them moving smoothly.
  • Avoiding injuries – Accidents happen, but some injuries can be avoided with proper precautions. A person should wear protective gear when playing sports, use proper lifting techniques, and avoid lifting objects that are too heavy.
  • Maintaining good posture – A person should be mindful of keeping the back straight when sitting, standing, and walking.
  • Quitting or not starting smoking –  Smoking is harmful to the body’s tissues and bones. Abstaining from smoking as it is harmful to bones and body tissues
  • Eating a healthful diet – A balanced diet of fruits, vegetables, whole grains, and lean protein contains nutrients that the bones and joints need.
  • Shockwave therapy – is another therapy that appears to be better than steroid injections and as effective as RF ablation with better long-term outcomes. Shockwave therapy uses the same technology that breaks up kidney stones.
  • Radiofrequency ablation – This procedure uses radiofrequency waves to shut down a nerve in the affected facet joint. This stops the nerve from sending pain signals to the brain.
  • Trying supplements – Some people may benefit from calcium or vitamin D supplements to keep bones healthy. People should always discuss supplements with a doctor before taking them.
  • Preventing injuries through the use of protective gear and proper lifting techniques
  • Eating a healthy diet with vegetables, fruits, lean protein, and whole grains
  • Using supplements such as vitamin D or calcium to promote bone health
  • Maintaining a proper posture while sitting, standing, or walking

Medicine and Drugs for

  • Analgesics – It is basically paracetamol with prescription-strength drugs that relieve pain but not inflammation.
  • Muscle Relaxants –  These medications provide relief from spinal muscle spasms.  Muscle relaxants, such as baclofen, tolperisone, eperisone, methocarbamol, carisoprodol, and cyclobenzaprine, may be prescribed to control muscle spasms.
  • Neuropathic Agents – Drugs(pregabalin & gabapentin) that address neuropathic—or nerve-related—pain. This includes paresthesia, radiating pain with numbness, diabetic neuropathy pain, myalgia, burning, numbness, and tingling sensation
  • Opioids – Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision.
  • NSAIDs – Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include mainly or first choice etodolac, then aceclofenac, etoricoxib, ibuprofen, and naproxen.
  • Calcium & vitamin D3 – To improve bone health and healing fracture. As a general rule, men and women age 50 and older should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day.
  • Glucosamine & Diacerein, Chondroitin sulfate – can be used to tightening the loose tendon, cartilage, ligament, and cartilage, ligament regenerates cartilage or inhabits the further degeneration of cartilage, ligament. The dosage of glucosamine is 15oo mg per day in divided dosage and chondroitin sulfate approximately 500mg per day in different dosages may be taken.[rx]
  • Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc.
  • Dietary supplement  – A dietary supplement is a manufactured product intended to supplement one’s diet by taking a pill, capsule, tablet, powder, suspension, or liquid to remove general weakness & improved health.[rx] A supplement can provide micronutrients either extracted from plants, seafood sources that are synthetic in order to increase the quantity of their consumption facet joints arthropathy. The class of nutrient compounds includes all kinds of vitamins, minerals, fiber, fatty acids, and amino acids.
  • Antidepressants – A drug that blocks pain messages from your brain and boosts the effects of endorphins (your body’s natural painkillers).
  • Anesthetic injections – This is when a doctor uses a needle to inject a pain reliever or anesthetic directly into the spine.
  • Corticosteroid – to healing the nerve inflammation and clotted blood in the joints. Steroids may be prescribed to reduce the swelling and inflammation of the nerves. They are taken orally (as a Medrol dose pack) in a tapering dosage over a five-day period. It has the advantage of providing almost immediate pain relief within a 24-hour period.
  • Topical Medications – These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin.
  • Triamcinolone acetonide Injection with local anesthesia – In lumbar epidural analgesia, the medication is injected into what is known as the epidural space (“epidural injection”). The epidural space surrounds the spinal cord and the spinal fluid in the spinal canal. This is also where the nerve roots are located. During this treatment, the spine is monitored using computer tomography or C- arms electromyography to make sure that the injection is placed at exactly the right spot.[rx]
  • Stem Cell Regeneration – Stem cell regeneration is a non-invasive and experimental treatment for damaged and painful facet joints. For many years patients have achieved promising results from targeted stem cell treatments of the hip and knee joints, and in the facet joint, this is also possible. During the treatment, stem cells are carefully injected into the facet joints under CT imaging guidance by an orthopedic specialist. The cells respond to inflammatory signals from the arthritic joint and start working to repair and regenerate the joint. This can be assisted with shockwave therapy (mentioned above) and other supportive therapies.

Spine surgery

  • A surgical procedure known as spinal fusion is employed to fuse the affected spinal bones together into one bone. This aids in mitigating pain by preventing the damaged facet joints from moving. Total Lumbar Facet Replacement”, which is a new motion-preserving solution where the facet joints are removed and replaced with artificial joints. This restores healthy height and movement to the damaged part of the spine.
  • For mild to moderate Facet Arthropathy presenting with a degenerative spinal disc at the same level, Artificial Disc Replacement is also an option. The controlled movement of the New-Generation ESP & M6 Artificial Discs protects the facet joints, and when natural height and movement is re-introduced to the damaged spinal level with ADR, then we observe cases where Facet Joint rehabilitation is possible.
  • If the patient is not a candidate for a motion-preserving solution, then a spinal fusion can be offered as a ‘last line of defense’. In most forms of a spinal fusion, the surgeon removes the facet joints between the levels of the spine that are to be fused together, which effectively eliminates the facet joints as a source of future symptoms.
  • In spinal fusion, the affected vertebrae can be fused together into one piece to keep the facet joints from moving and irritating the spinal column

References