From the Guidelines
Treatment for early lower lumbar facet osteoarthropathy should begin with conservative measures, including non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy, to reduce inflammation and pain, as well as improve quality of life. The impression indicates early lower lumbar facet osteoarthropathy, which is degenerative arthritis affecting the facet joints in the lower lumbar spine. According to the 2019 American College of Rheumatology guideline for the management of osteoarthritis 1, patients with OA should be treated with a combination of pharmaceutical and nonpharmaceutical interventions.
Key aspects of treatment include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily with food or naproxen 500mg twice daily for 1-2 weeks to reduce inflammation and pain
- Physical therapy focusing on core strengthening and lumbar stabilization exercises, with sessions 2-3 times weekly for 4-6 weeks
- Application of heat for 15-20 minutes several times daily to help relieve muscle spasm
- Activity modification to avoid positions that extend the spine
- Consideration of facet joint injections with a corticosteroid and local anesthetic if conservative measures fail to provide adequate relief
- Weight loss for overweight patients to reduce mechanical stress on the facet joints, as osteoarthritis is characterized by pathology involving the whole joint, including cartilage degradation, bone remodeling, osteophyte formation, and synovial inflammation, leading to pain, stiffness, swelling, and loss of normal joint function 1.
This condition results from wear and tear on the cartilage within the facet joints, causing inflammation, bone spur formation, and pain, particularly with extension or twisting movements of the spine. Early intervention can help manage symptoms and potentially slow progression of the degenerative process.
From the Research
Diagnosis and Treatment of Lumbar Facet Joint Pain
- The diagnosis of lumbar facet joint pain is challenging and requires a comprehensive approach, including physical examination, clinical assessment, and diagnostic blocks 2, 3.
- Imaging modalities such as fluoroscopy, computed tomography (CT), and single photon emission computed tomography (SPECT) may be used to guide diagnostic and therapeutic interventions, but their diagnostic value is limited 2.
- Diagnostic facet joint nerve blocks are considered the most reliable diagnostic measure for facet joint pain, with a level of evidence of I to II and moderate to strong strength of recommendation 2, 4.
Treatment Options for Lumbar Facet Joint Pain
- Therapeutic facet joint interventions, including lumbar radiofrequency ablation, therapeutic lumbar facet joint nerve blocks, and lumbar facet joint intraarticular injections, may be effective in managing chronic low back pain, but the evidence is limited and the strength of recommendation varies 2, 5, 3.
- Lumbar radiofrequency ablation has a level of evidence of II with moderate strength of recommendation, while therapeutic lumbar facet joint nerve blocks have a level of evidence of II with moderate strength of recommendation 2.
- Lumbar facet joint intraarticular injections have a level of evidence of IV with weak strength of recommendation, and their effectiveness is uncertain 2, 5.
Combination Therapy for Lumbar Facet Joint Pain
- The combination of physiotherapy and lumbar facet joint injections may be beneficial in managing chronic low back pain, with land-based lower back mobility exercise and soft tissue massage appearing to have a positive effect in the short term and possibly in the longer term 5.
- However, the evidence is limited, and further research is needed to determine the effectiveness of combination therapy for lumbar facet joint pain 5, 4.