How Much Are You Willing to Pay for Facet Joint Pain?
Lower back pain is one of the most common sources of discomfort, often severe enough to hamper normal daily activities. Family life, job performance, and social activities start to slip. It may be short-lived, e.g. due to injury, and manageable with over-the-counter pain relievers and home treatment so it soon eases off. However, other conditions can lead to constant or frequently recurring pain. One such condition is called facet joint osteoarthritis, or simply arthritis in the facet joints.
Facet joints are located between each vertebra (backbone) where small bone protrusions meet. The tips of these protrusions are lined with cartilage that cushions and lubricates the spine’s flexibility. Arthritis in these joints occurs when overuse or wears the cartilage down. Pain comes from bone rubbing on bone, and compression of nerves as space between vertebrae narrows.
Caring for facet joint pain is costly
Pain demands attention yet clouds decision-making. When a person is in pain, the mind focuses on stopping the pain rather than the impact on the individual’s wallet—let alone the cost to society. However, many studies have identified how expensive it is on a personal and broader level to care for lower back pain. Here are some of the areas in which small and large costs can rack up.
- Medical expenses – these range from inexpensive home remedies (heating pads; massage; over-the-counter nonsteroidal anti-inflammatory drugs or NSAID’s, etc.) to medical costs for things like diagnostic imaging and image-guided injections into the facet joint nerves.
- Lost work –both the employee and the employer lose money. If too many days or hours on the job are lost, the employee may end up with lost wages and potentially higher medical insurance premiums; worst case scenario is losing one’s job, which then impacts the worker’s family. As for the employer, the problem of job absenteeism may mean pressuring other employees to take on extra work so their performance slips, or having to conduct a hiring search and training a new person—all things that can eat into the profit margin of the company.
- Both of the above costs have a wider ripple effect. According to a 2018 study, “Low back pain (LBP) is one of the most common pain syndromes and is an enormous burden and cost generator for society. The high health care costs may be attributed to multiple factors, including lack of an accurate diagnosis, imaging overuse, unwarranted surgery and working stoppages.”i These problems lead to higher health insurance costs, both private and public, eventually effecting almost everyone. Also, since arthritis most commonly occurs with aging, elderly people with chronic low back pain are less able to perform daily tasks, placing a greater burden on caretakers. It is estimated that 15-45% of low back pain is due to facet joint arthritis,ii giving a hint to the proportionate financial burden of this condition.
Suffering: a different kind of cost
There is another type of price tag that accompanies facet joint pain: physical and emotional suffering. This can’t be measured in dollars and cents, but chronic pain drains a person’s psychological savings account. Each of us has our own “cocktail” of inner resources that get us through our down days. These are intangible qualities like optimism, courage, faith, sense of humor, serenity, stoicism, etc. Each has our own unique combination. Like a passbook account, we make “deposits” during good times that fortify us, and we make “withdrawals” during a crisis or a hard time that drags on.
Chronic, severe pain depletes this inner savings account. As the supply diminishes, the ability to cope gives way to depression, fear, anxiety, worry, anger—even suicidal thoughts. These are real states in the brain. “Acute pain and chronic pain are encoded in different regions of the brain. Chronic pain can be considered a driving force that carves cortical anatomy and physiology, creating the chronic pain brain/mind state.”iii While the suffering person may feel isolated, dealing with the person in physical and emotional pain can sap family and friends—another ripple effect.
Treating facet joint pain
Facet joint pain can be tricky to diagnose. Imaging may reveal arthritic deterioration but it may not correlate with the patient’s pain symptoms. It can overlap with other sources of low back pain like injury or disc problems in the spine. In its early stages, it may respond to the home remedies mentioned earlier, but as bone and/or nerve pain worsen, these won’t do the job. I have previously written on repeatable injections to numb the nerve pain for a few months but it’s unclear how effective these are, and how often they can be repeated.
A new technology, MRI-guided Focused Ultrasound (MRgFUS), is a noninvasive outpatient procedure that stops the pain at its source. Targeting many beams of ultrasound precisely on the nerve at the arthritic joint creates enough heat to destroy the nerve without affecting other functions. This eliminates the need for medications and injections while offering welcome and lasting pain relief.
Stop paying the high price of facet joint pain. For more information, contact the Sperling Medical Group.
iPerolat R, Kastler A, Nicot B, Pellat JM et al. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018 Oct;9(5):773-789.
iiiGorczyca R, Filip R, Walczak E. Psychological aspects of pain. Ann Agric Environ Med. 2013;Spec no. 1:23-7.
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