From the Guidelines
The best treatment for facet degeneration and back pain typically involves a multi-modal approach, starting with conservative measures such as physical therapy, over-the-counter medications like acetaminophen or NSAIDs, and heat or cold therapy, as recommended by the American College of Physicians and the American Pain Society 1.
Key Components of Treatment
- Physical therapy focused on core strengthening and spine stabilization exercises to support the affected joints
- Pain management with over-the-counter medications like acetaminophen (500-1000mg every 6 hours as needed) or NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily)
- Heat therapy for 15-20 minutes several times daily to relax muscles, while cold packs for 15-20 minutes can reduce inflammation
Additional Interventions for Insufficient Relief
- Facet joint injections with corticosteroids and local anesthetic for months of pain reduction by decreasing inflammation at the joint
- Radiofrequency ablation for persistent pain, which uses heat to disrupt pain signals from the medial branch nerves for 6-12 months of relief
Lifestyle Modifications
- Weight management
- Proper ergonomics
- Avoiding activities that worsen pain These approaches target the underlying inflammation and mechanical stress on the facet joints, which become painful when the cartilage between them degenerates and bone spurs develop, causing irritation of surrounding nerves. According to the guidelines, medications with proven benefits should be considered in conjunction with back care information and self-care, with an assessment of severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy 1.
From the Research
Treatment Options for Facet Degeneration and Back Pain
- The American Society of Interventional Pain Physicians (ASIPP) guidelines 2 recommend the use of diagnostic facet joint nerve blocks, with a level of evidence of I to II and moderate to strong strength of recommendation, to diagnose facet joint pain.
- Therapeutic facet joint interventions, such as lumbar radiofrequency ablation and therapeutic lumbar facet joint nerve blocks, have a level of evidence of II with moderate strength of recommendation 2.
- A narrative review of lumbar facet joint injections and physiotherapy treatments, including land-based lower back mobility exercise and soft tissue massage, suggests that these treatments may be beneficial for chronic low back pain, with a short-term positive effect on pain relief 3.
- A study on the effectiveness of lumbar facet joint block with local anesthetic agents and/or steroid medication found that 18.7% of patients reported long-lasting relief of low-back pain and/or leg pain, while 15.2% noticed a general improvement in their pain 4.
Recommendations for Treatment
- The ASIPP guidelines 2 recommend the use of fluoroscopic or computed tomography (CT) guidance for all facet joint interventions, with a level of evidence of I and strong strength of recommendation.
- The guidelines also recommend avoiding opioid analgesics during diagnosis with interventional techniques, with a level of evidence of II and moderate strength of recommendation 2.
- A consensus practice guideline on interventions for lumbar facet joint pain recommends the use of lumbar medial branch radiofrequency ablation (RFA) for well-selected individuals, with medial branch blocks being more predictive than intra-articular injections 5.
Adjacent Level Degeneration and Facet Arthropathy
- A randomized clinical trial found that adjacent level degeneration (ALD) developed with similar frequencies in patients treated with disc prosthesis surgery and those treated with rehabilitation, while index level facet arthropathy (FA) appeared or increased in 34% of patients treated with surgery 6.
- The development of ALD and FA was not related to clinical outcome, suggesting that these conditions may not be directly related to treatment outcomes 6.