Pain of facet origin
Facet syndrome is defined as axial pain of traumatic (60%) or degenerative origin arising from the facet or interapophyseal joints and adjacent soft tissues.
What is pain of facet origin?
When facet pain occurs in the cervical area, the dysfunction –irritation and inflammation of the cervical facet joints– is accompanied by pain in that area, with irradiation to the occipital area, shoulder girdle and upper extremities up to the elbow.
In the dorsal joints the pain refers to the area between the shoulder blades radiating to the thoracic area up to the sternum.
At lumbar level it produces, in addition to local pain, pain in the gluteal area, hip and referred pain in the lower extremities up to the knee, simulating sciatica but without neurological deficits. It is associated with stiffness first thing in the morning or after prolonged inactivity and the pain usually increases with lumbar hyperextension.
How can pain of facet origin be treated?
As a first option, conservative treatment will be considered, with analgesia and exercises prescribed by your spine specialist.
If this is not sufficient, your physician may indicate an ultrasound-guided infiltration to perform a facet block.
The ultrasound-guided treatment used for facet pain control is based on blockade of the facet joints, accompanied by blockade of the medial branch of the posterior nerve, which is responsible for the innervation of the facet joint and the intrinsic paraspinal musculature.
What does the facet block consist of?
It is performed with the patient lying face down, awake under sedation or local anesthesia. The injection of a mixture of corticosteroid and anesthetic is performed with ultrasound monitoring of the needle position.
This procedure can be repeated in multiple sites depending on the location of each person’s pain and usually lasts about 30 minutes.
Shortly after the procedure, the patient can walk and return home, although it is recommended that he/she does not drive and is accompanied. When the anesthesia wears off, the back pain may return since the corticosteroid may take 7 to 10 days to take effect. In general, patients return to normal life and work within 24 hours.
The effect of the block usually lasts from months to years, especially if it is associated with exercise, adequate body weight and postural hygiene, rather than as the only treatment.
What are the risks of facet block?
The risks of facet block are slight, the procedure being guided at all times, and include local discomfort in the puncture area that subsides in a few hours with conventional analgesic treatment and, in people sensitive to pain, vasovagal syncope may occur, which is the most common form of fainting (associated with heat, sweating, nausea, hypotension). It is not serious and subsides with Atropine.
From the Rehabilitation Medicine and Complementary Therapies Unit at Barcelona Spine Institute we offer our patients the most appropriate personalized treatment. Do not hesitate to contact your specialist and request an appointment.