Treatment options for facet joint pain

To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help.

There are a number of conservative care treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:

Successful long-term treatment involves proper exercises, with instruction by a trained physical therapist or other healthcare provider.
Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase). A very useful posture when standing or sitting is the pelvic tilt - where one pinches together the buttocks and rotates forward the lower pelvis - and holding that position for several seconds, done several times per day.
Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes
Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks
The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAID’s (e.g. ibuprofen) and the more recent Cox-2 inhibitors (e.g. Celebrex)
Chiropractic manipulations or osteopathic manipulations may provide pain relief
For the neck, a restraining collar may bring temporary relief, as may also cervical traction. A suitable supportive neck pillow is often essential and abnormal nighttime flexion positioning of the neck, such as when using a pile of pillows, is to be avoided.

More lasting relief of the facet joint problem can be obtained by destroying some of the tiny nerve endings serving the joints. This can be accomplished by a tip freezing or an electrified hot probe technique (also known as a facet rhizotomy) performed under careful x-ray control, (or for a lesser time by a carefully controlled injection of botox toxin which treats the muscle spasm).

In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require a bone fusion surgery to stop both the associated disc and facet joint problems. Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.

Fortunately, for the vast majority of patients, a combination of change in life style, medication and proper exercise and posture will reduce the problem to a manageable level.

By: Charles Dean Ray, MD, FACS
December 10, 2002