By Dr. Micah Burns, Interventional Pain Specialist
Introduction
Facet-mediated pain, a common cause of spine discomfort, manifests anywhere in the back, most commonly in the low back (lumbosacral spine) and neck (cervical spine). This post aims to shed light on the causes, diagnosis, and treatments for facet-mediated pain, with a special focus on radiofrequency ablation.
Understanding Facet Joints in the Spine
The spine consists of vertebrae, which are interconnected by facet joints. These joints provide stability and allow for movement. The facet joints can become a source of pain due to various reasons:
- Age-related wear and tear: Leading to arthritis in the facet joints.
- Injury: Such as whiplash or strains that affect the neck or lower back.
- Posture and lifestyle factors: Contributing to joint stress and degradation.
Symptoms include localized pain, stiffness, and discomfort during certain movements. The pain from the facet joints can radiate and mimic other types of pain, e.g. sciatica in the back, or shoulder pain in the cervical spine.
Diagnosing Facet-Mediated Pain
Diagnosis typically involves:
- Physical Examination: Assessing pain points and mobility.
- Imaging Tests: Like X-rays or MRIs to visualize joint degradation.
- Diagnostic Injections: A numbing agent is injected next to the nerve, providing sensation to the suspected joint. Relief following the injection indicates facet-mediated pain with a high degree of certainty. This can help differentiate facet-mediated pain from other types of pain in the area.
Radiofrequency Ablation for Facet-Mediated Pain
Radiofrequency ablation (RFA) is a targeted treatment for facet-mediated pain. The procedure involves:
- Preparation: Local anesthesia is administered.
- Needle Placement: Guided by fluoroscopy, a needle is positioned near the affected facet joint nerves.
- Nerve Testing: A mild electrical current ensures correct needle placement.
- Ablation: Radiofrequency energy is passed through the needle, disabling the nerves and blocking pain signals.
Benefits of RFA in Treating Facet-Mediated Pain
- Targeted pain relief: as opposed to an epidural, which can help with certain types of spine pain but has less reliability and specificity in facet-mediated pain.
- Avoidance/minimization of multiple steroids (cortisone) injections, and the resulting possible side effects from steroids which can include weight gain, immunosuppression, high blood glucose (blood sugar), osteoporosis and glaucoma.
- Minimal invasiveness and quick recovery: this procedure is a needle through the skin and so is not considered surgery as there is NO INCISION.
- Potential long-term relief from chronic pain: the pain relief from this procedure can last on average for one year.
- Reduced reliance on pain medication.
Conclusion
For those experiencing chronic back or neck pain originating from facet joints, radiofrequency ablation offers a promising treatment avenue, as part of a multimodal, multidisciplinary treatment plan. Full recovery takes time, and the pain-relieving effects are optimized when combined with proper and targeted physiotherapy.
Consult with your pain management specialist to explore if RFA is an appropriate option for you.
