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The evidence regarding facet joint injections is inconclusive.

Facet Joint Injection Benefits are Hard to Prove

Those who live in developed nations enjoy many benefits that are easily taken for granted. There is enough food to go around, dwellings are climate-controlled, transportation and travel are expedited by conveyances capable of both speed and safety, technology brings efficiency and imagination to both work and leisure, and medicine boasts unprecedented achievements in curing disease and extending life with high quality for those with chronic diseases. It’s ironic, then, that about 70% of adults in this “resource rich” environment will experience lower back pain at one time or another, and of those whose pain lingers more than a few weeks, 82% will still have pain a year later.i

Chronic back pain remains one of those mysteries that science has yet to decode. Doctors have an arsenal of treatments at their disposal, yet many patients with chronic back pain, especially lower back pain, spend months or years trying one treatment after another in search of lasting relief. There is an immense body of literature on the subject, and yet there is no conclusive evidence of single protocol of medication or injections that has lasting value for a majority of people who try them.

A well-structured review of published literature by Hall & McIntosh (2008) summarized their work after combing through studies that met their criteria. In particular, they prioritized randomized controlled trials and rejected papers with certain research flaws. Just reading the list of back pain therapies they found is practically overwhelming: “acupuncture, analgesics, antidepressants, back schools, behavioural therapy, electromyographic biofeedback, exercise, injections (epidural steroid injections, facet joint injections, local injections), intensive multidisciplinary treatment programmes, lumbar supports, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulative therapy, traction, and transcutaneous electrical nerve stimulation (TENS).”ii Perhaps the most important question they raise is: what is the evidence that any of these are more effective than a placebo (a harmless look-alike substitute used in comparison studies)?

What they found supports intensive exercise and physical therapy programs, and that over-the-counter nonsteroidal anti-inflammatories such as acetaminophen and ibuprofen may improve pain and function without adverse effects. Beyond that, there is inconclusive evidence that more invasive interventions such as local injections produce consistent, significant relief from chronic back pain.

This brings up injections for a very specific source of back pain, facet joint osteoarthritis. First of all, the conventional method for gaining a definitive diagnosis of facet joint pain is a test injection of an anesthetic into the joint. If the patient has a few hours of freedom from pain, this is considered diagnostic. However, the patient may then be referred for physical therapy and exercise – but if that produces no improvement, facet joint injections (combination anesthetic and steroid) may be recommended. Yet, according to Hall & McIntosh, such injections “may be no more effective than placebo at reducing pain.” In short, the merits of these injections are hard to prove.

A noninvasive alternative to facet joint injections is MRI-guided Focused Ultrasound (MRgFUS), which uses imaging to identify the source of pain, and to destroy it using sonic energy (sound waves). The outpatient treatment uses no drugs, injections or surgery. It is safe, and effectively brings significant pain relief to the majority of people who undergo the treatment.

The Sperling Medical Group offers MRgFUS for the relief of facet joint pain that no longer responds to exercise, physical therapy, oral medication or other interventions. If you suffer from facet joint pain and have tried injections, or your doctor is recommending injections but you don’t like the idea, contact the Sperling Medical Group for more information about MRgFUS for facet joint pain.

iHall H, McIntosh G. Low back pain (chronic). BMJ Clin Evid. 2008 Oct;2008. Pii:1116

Facet Pain