Facet Syndrome

Lumbar spine. Low back pain originating from the lumbar facet joints can present in many ways. There exists significant overlap between pain from the facets joints and that of other spinal and non-spinal structures. (e.g. intervertebral discs, spinal nerves, sacroiliac joints, spondylolysis, etc.) Your physician may develop a high suspicion of facet joint pain after listening to your history and performing a proper physical examination; however, research has shown that it is impossible to reliably make a diagnosis without further diagnostic testing.

Thoracic spine. Mid back pain that is derived from the thoracic facet joints is quite rare. When it does occur it often presents with pinpoint pain along the spine. Sometimes it causes pain along the shoulder blade. Movements such as sideways bending, sideways rotation, or even overhead lifting may exacerbate the patient's symptoms.

Cervical spine. Neck pain that is derived from the cervical facet joints is actually very common! Research studies show that the cervical facet joints may actually be the most common source of neck pain. However, similar to the lumbar spine, there exists significant overlap between pain from the facets joints and that of other spinal and non-spinal structures (e.g. intervertebral discs, spinal nerves, upper back muscles, muscles, TMJ, etc.). Your physician may develop a high suspicion of facet joint pain after listening to your history and performing a physical exam. Again, it is impossible to reliably make a diagnosis without further diagnostic testing.

Facet Joint Pain

Background

Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice.

Methods
Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The prevalence of facet joint pain was determined using controlled comparative local anesthetic blocks (1% lidocaine or 1% lidocaine followed by 0.25% bupivacaine), in accordance with the criteria established by the International Association for the Study of Pain (IASP). The study was performed in the United States in a non-university based ambulatory interventional pain management setting.

Results
The prevalence of facet joint pain in patients with chronic cervical spine pain was 55% 5(95% CI, 49% – 61%), with thoracic spine pain was 42% (95% CI, 30% – 53%), and in with lumbar spine pain was 31% (95% CI, 27% – 36%). The false-positive rate with single blocks with lidocaine was 63% (95% CI, 54% – 72%) in the cervical spine, 55% (95% CI, 39% – 78%) in the thoracic spine, and 27% (95% CI, 22% – 32%) in the lumbar spine.ConclusionThis study demonstrated that in an interventional pain management setting, facet joints are clinically important spinal pain generators in a significant proportion of patients with chronic spinal pain. Because these patients typically have failed conservative management, including physical therapy, chiropractic treatment and analgesics, they may benefit from specific interventions designed to manage facet joint pain.

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions Laxmaiah Manchikanti,1 Mark V Boswell,2 Vijay Singh,3 Vidyasagar Pampati,1 Kim S Damron,1 and Carla D Beyer1