Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Facet joint injections

They consist of injecting a substance, usually a steroideal anti-inflammatory agent -cortisone derivatives- and/or anesthesia in the facet joint.

Objective

To reduce inflammation and pain originating in the facet joint.

Theoretical base

It has been proven that pain nerves are activated in painful facet joint disorders. Activation of these nerves elicits pain and provokes release of substances implied in neurogenic inflammation.

Cortisone derivatives have very potent anti-inflammatory effects, but their risks and contraindications disallow their continuous administration . When corticoids are administered only the portion from the bloodstream reaching the swollen area is effective. To increase anti-inflammatory efficacy and decrease risks, steroids are injected directly into the facet joint to obtain a potent local effect and less adverse effects.

Thereby, the effect of substances released by pain nerves is neutralized and inflammation decreased.

Higher doses of local anesthetics reach the joint when administered through a joint injenction. Its objetive is to inhibit pain nerves.

Evidence of efficacy

The existing evidence-based recommendations coincide in stating that facet joint injections have no effect in acute patients or in chronic ones, regardless of the substance injected.

Injections with anaesthetics can improve pain transitorally in patients where pain is due to alterations of the joint. Therefore, although they are not effective as treatment, they are used as tests before rhizotomy.

Risks and contraindications

Potential serious complications are rare. Most common are an increase in back pain, which subsides in a few days, and temporary pain in the injected site. These have been the reported side effects. Other potential adverse effects are infection at injection site, hemorrhage, neurological damage, and chemical meningitis.

Indications

The existing recommendations based on scientific evidence do not advise facet joint injections.

Currently, it is only reasonable to use them as a test to value one of the selection criteria in patients where rhizotomy may be considered.