Back pain treatment utilizing facet joint (the joints of the spine) injections was a very popular treatment option in the 1980’s and 90’s. Much of the popularity stemmed from earlier research which depicted the facet joints as a primary source of back pain with suggestion that irritation of the facet joint could also result in associated leg pain. This early research led to the use of direct injection therapy to treat low back pain.
The use of facet joint injections fell out in favor following a paper published in the New England Journal of Medicne in 1991 which suggested that the use of facet joint injections were of little value in the treatment of low back pain.
However, over the past few years I have seen an increase in the popularity of facet joint injections which prompted me to look into the matter further.
My curiosity peeked when a 60 year old male patient was referred to me with complaints of low back pain. He told me that he was also scheduled for facet joint injections because x-ray and MRI studies identified arthritic changes in his face joints. After examining him, though, I had other thoughts.
As I said earlier, the facet joint has received a lot of attention as a potential cause of back pain. Back pain treatment to address the facet joint includes manipulation, injection, eliminating the sensory nerves to the joint, and even artificial joint replacement. With all this attention you would think that the facet joint is a unique source of back pain. But just how unique is it?
In a study of 647 human spines, the authors concluded that facet joint arthritis is a universal finding in the human spine. Here’s the breakdown of the incidence of arthritis in the facet joints:
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20 - 29 years of age 57%
30 - 32 years of age 82%
40 - 49 years of age 93%
50 - 59 years of age 97%
60 years of age and over 100%
Facet joint arthritis appeared to occur more frequently in men and affected the L4,L5 facet joints more commonly. Interestingly, this level of the spine is where we see most herniated discs in the low back.
So with this amount of evidence showing the frequency of facet joint arthritis, you might think that facet joint injections would be effective, right? Think again.
A recent commentary in the Journal of the Royal Society of Medicine concluded that use of facet joint injections could no longer be justified in the treatment of back pain because of a lack of evidence to support the effectiveness of the procedure and cost effectiveness. To quote one researcher, “the use of facet joint injection for low back pain is one of a treatment driven by hope, enthusiasm, and conviction, not by science”.
Bottom line: there is no justification for the use of facet joint injections to treat low back pain.
Rememnber that patient I told you about earlier? After I examined him I explained to him that I thought injection therapy would be a waste of his time and money. I suggested that we, instead, treat the muscle imbalances I had indentified.
And the result?
Two days later he was able to get out of bed pain free. Two weeks later he was back on the golf course shooting his typical 98 and begging me to come up with some way to shave his handicap.
In the Erase Your Back Pain program, I show you how to assess and treat yourself so that you can avoid unnecessary and expensive medical treatment. Ready to start feeling better? Go here NOW! ==> No More Back Pain!
I welcome your questions and comments. Please let me know your most burning question regarding your back pain by commenting below.
Dedicated to Erasing Your Back Pain,
Malton A. Schexneider, PT, MMSc
Clinical Specialist
Orthopaedic Physical Therapy
6 comments ↓
To late Dr. wish I had read this months ago. I’ve already had three different facet injections and something called radiofrequency and I think that may have damaged my nerves as I have had nothing but pain before and since. I am on alot of pain medicine and truthfully I could not do anything without all the drugs. I wish to hear from you concerning this if you have any recommendations.
Linda,
Sorry to hear about your woes. I know lots of people are in your shoes.
This procedure has about a 50% success rate and, in some cases, actually makes the patient worse. And, to make matters worse, as the nerve grows back over the course of 12-18 months the pain can come back.
A better option would be to address the muscle imbalances that got the joints in the shape they’re in in the first place. Have you looked at my program? Check it out here: http://eraseyourbackpain.com/program
Let me know if i can help.
Malton
Dear Doc,
I also, had facet joint injections, but to no avail. Actually, the last one I had, I did get relief immediately–and felt wonderful..until I realized that the doctor had hit my nerve instead, and I was temporarily paralyzed for almost 36 hours from my waist down! I’d driven myself to the clinic, so I had to find someone to drive me home, leave my car 45 miles away in the parking lot, for 2 days, until I got a ride back to town to get it. Never again!!! I’ve had 4 surgeries on my spine to date, the last 2 being fusions at levels
L4-5 &L5-S1. I’ve recently gone through the trial period of a spinal cord stimulator..and I’m awaiting surgery for the permanent one to be placed, in 3 weeks. I’ve developed ‘arachnoiditis’ from all the MRI’s etc., and I have just massive amounts of scar tissue buildup, which causes most of my pain at this time—the nerves are clumping and always seem ‘pinched.’ All of this was brought on by lifting wrong—twisting my upper body around without turning my lower body with it. I herniated 2 discs and had a tear also. This happened 6 yrs. ago—and it’s still ongoing. Any ideas? I’m open to anything, as this ‘accident’ has taken alot of good years away from me.
well i have degenerative disc in my back & neck plus pinched nerves in the neck. I’ve had 3 shots in the back, they didn’t work plus a second set of another type of shot (only one of those) needless to say nothing this far has worked.I was told i needed surgery but i lost my insurance & when i went back to my dr. he said there was nothing he could do that he couldn’t help me, but last year he said i needed surgery. I’m in constant pain all the time with my back & neck , i can’t get any sort of pain medication. What do you suggest i do? Or what can i do?
I assume the injections you speak of are distinctly different from the epidural kind. I’ve had two of the latter and they seem to have done me a great deal of good. Comment?
I am on my third lot of facet joint injections….they have been a life saver for me.T10/11 T11/12 T12/L1 have been injected. I seem to suffer from a condition called TLJ syndrome and have had back problems for 12 years. Im now 48 so i was quite young to have chronic back pain. I have tried everything from orthotics, manipulation, physio, traction and exercise. The only successful relief i got was from the facet joint injections with steroid. Hope this is helpful to someone.
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