Treatment of facet joint pain often includes physical therapy, as well as interventional procedures. Using proper back mechanics and maintaining a healthy weight are also important. Treatment of facet joint syndrome may include:
• Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs. They are often the first line medications used to treat pain and reduce inflammation caused by arthritis, tendonitis, and bursitis. NSAIDs are inexpensive and effective. There are side-effects associated with NSAIDs, such as upset stomach, ulcer, and possible interference with kidney function. Severity of the side-effects may increase the longer a patient takes NSAIDs. Many people do experience significant relief when taking this medication.
• Physical Therapy – Successful long-term treatment often involves physical therapy. A therapist will work with a patient to create a program to include a series of stretches and strengthening exercises. There are many stretching exercises for relieving pain and elongating the spine that will help ease discomfort. Therapists will work with the patient to strengthen the core and lower back muscles. Most importantly, physical therapists will give guidance on the ways to move and perform daily activities in a more comfortable manner.
• Exercise – Many patients see relief after beginning an exercise program on top of the physical therapy. Maintaining a healthy weight is important for spine health.
• Heat and cold may help during painful episodes – heat wraps, hot baths or showers, heating pad, or cold pad applications.
• Facet joint injections—The facet joint can be injected with steroid and numbing medications. This is a very effective way to treat pain from inflammation of the facet joint. Using fluoroscopy (x-ray guidance) a needle is carefully inserted into the joint and medication injected. This procedure should only be done with image guidance to insure the correct needle location. This procedure is done in the office and takes only a few minutes. For many patients, this will provide several months of relief. This procedure can be repeated if necessary.
• Medial branch radiofrequency ablation– The medial branch nerve supplies the feeling to the facet joint. It is a small nerve and is not responsible for leg strength. This nerve may be temporarily numbed with local anesthetic during a procedure called a medial branch block. If a person has significant pain relief with this block we can infer that the facet joint is the cause of the pain. We may then proceed with a radiofrequency procedure. This procedure damages the nerve so that it cannot send the pain signal. This is a relatively simple procedure that is done in the office. This can provide very good long term pain relief.