12. Pain Originating from the Lumbar Facet Joints

Although the existence of a “facet syndrome” had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial low back pain. Most commonly, facetogenic pain is the res...

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Bibliographic Details
Published in:Pain practice 2010-09, Vol.10 (5), p.459-469
Main Authors: Van Kleef, Maarten, Vanelderen, Pascal, Cohen, Steven P., Lataster, Arno, Van Zundert, Jan, Mekhail, Nagy
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Diagnosis, Differential
Evidence-Based Medicine
Guidelines as Topic
Humans
Injections, Intra-Articular
low back pain
lumbar facet
Lumbar Vertebrae - pathology
Pain - diagnosis
Pain Management
Pain Measurement
radiofrequency treatment
Zygapophyseal Joint - innervation
Zygapophyseal Joint - physiopathology
zygapophysial joint
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Summary:Although the existence of a “facet syndrome” had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low‐level trauma, leading to inflammation and stretching of the joint capsule. The most frequent complaint is axial low back pain with referred pain perceived in the flank, hip, and thigh. No physical examination findings are pathognomonic for diagnosis. The strongest indicator for lumbar facet pain is pain reduction after anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Because false‐positive and, possibly, false‐negative results may occur, results must be interpreted carefully. In patients with injection‐confirmed zygapophysial joint pain, procedural interventions can be undertaken in the context of a multidisciplinary, multimodal treatment regimen that includes pharmacotherapy, physical therapy and regular exercise, and, if indicated, psychotherapy. Currently, the “gold standard” for treating facetogenic pain is radiofrequency treatment (1 B+). The evidence supporting intra‐articular corticosteroids is limited; hence, this should be reserved for those individuals who do not respond to radiofrequency treatment (2 B±).
ISSN:1530-7085
1533-2500
DOI:10.1111/j.1533-2500.2010.00393.x