Dealing with low back pain of facet origin

It is estimated that approximately 50-80% of the adult population will develop at least one episode of low back pain during their lifetime. Most people will improve spontaneously with conservative treatment without the need for surgery. In recent years there have been great advances in non-surgical techniques, and new products and systems have been developed to treat chronic low back pain.

But what exactly is low back pain and low back pain of facet origin?

Low back pain or lumbar pain is defined as pain located between the lower edge of the ribs and the lower limit of the buttocks. Eighty per cent of low back pain is uncomplicated and improves in less than 4-6 weeks. 15-20% respond to a specific cause and about 10% become chronic. There are numerous causes of low back pain (disc herniation, canal stenosis, spondylolisthesis, etc.), but one of the main causes, which often goes unnoticed, is low back pain of facet origin. This pain originates in the posterior articular complex of the spine and is usually associated with an arthritic process.

It is characterized, above all, by low back pain with morning stiffness lasting more than 30 minutes, improvement with movement but not with rest, inability to remain standing or sitting for long periods of time, awakening in the second half of the night due to alternating pain in both buttocks. This pain usually appears, fundamentally, from the fourth decade of life onwards and its incidence increases with age.

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Treatment of low back pain of facet origin

Treatment is initially conservative, combining anti-inflammatory drugs, such as celecoxib, with weak opioids, such as tramadol. Rehabilitation treatment with strengthening of the lumbar musculature is also recommended. In the event that conservative treatment is not effective, radiofrequency (heat injury) of the medial branch of the posterior lumbar root is indicated by the expert in the Pain Unit. This medial branch is the nerve that collects the sensitivity of each facet joint. It is divided into two branches, a superior one that innervates the joint at its level and an inferior one that innervates the joint at the lower level, so the procedure should be performed at least at two levels.

With proper patient selection, pain relief figures of 50-67% of patients are achieved. The procedure is performed on an outpatient basis under local anesthesia and is painless. After the procedure the patient can go about his normal life the following day, but it should be noted that the results of the procedure cannot be evaluated for at least two weeks. The procedure can be repeated a year after it has been performed, if necessary.

Edited by Patricia Pujante Crespo