Each vertebra in the spine joins its neighbour via three joints – the large disc in the front and two small facet joints behind, forming a triangle of joints surrounding the spinal canal.
The facet joints are most commonly affected by osteoarthritis (wear and tear arthritis). Facet joint pain can be felt over the affected joint but can also be referred – to the shoulder girdle, shoulder blade or arm in the case of the neck, or into the bony pelvis, hip or thigh in the case of the low back. It tends to be worse with extension of the spine (bending backwards).
Physiotherapy and Medication
Local treatments, such as heat, ultrasound and massage may give rapid improvement of symptoms. Long term relief is obtained by strengthening the supporting spinal muscles of the neck or low back – this builds up the body’s own brace for the spine.
Many people get relief with over the counter medications such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. NSAIDs can be very effective in reducing the inflammation of structures in the back and improve your symptoms. NSAIDs are not suitable for everyone , especially if you have a history of asthma, high blood pressure, kidney failure or stomach ulcers.
Muscle relaxant can be added for spasms.
If the pain is severe then narcotic pain killers can be considered but only for short periods as there is a risk of addiction and dependence if used incorrectly.
Facet Joint Injections
These can be extremely useful at relieving the pain caused by the arthritic facet joints. They can also help determine the source of back pain and plan future treatment. Local anaesthetic and cortisone is injected into the affected facet joints under X-ray control. The main aim of the injection is to alleviate the back pain, improve activity level and enhance the treatment of the physiotherapist.
If a facet joint injection is helpful for a short duration, a much longer period of pain relief can be obtained by heating the nerves supplying the affected facet joint.
Surgery is rarely used for pure facet joint disease and pain; however, it can be useful when facet joints develop osteophytes, (bony spurs) which, press on the spinal cord or nerves, usually affecting the lumbar or cervical spine.