12. Pain originating from the lumbar facet joints.
Although the existence of a "facet syndrome" had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low-level trauma, leading to inflammation and stretching of the joint capsule. The most frequent complaint is axial low back pain with referred pain perceived in the flank, hip, and thigh. No physical examination findings are pathognomonic for diagnosis. The strongest indicator for lumbar facet pain is pain reduction after anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Because false-positive and, possibly, false-negative results may occur, results must be interpreted carefully. In patients with injection-confirmed zygapophysial joint pain, procedural interventions can be undertaken in the context of a multidisciplinary, multimodal treatment regimen that includes pharmacotherapy, physical therapy and regular exercise, and, if indicated, psychotherapy. Currently, the "gold standard" for treating facetogenic pain is radiofrequency treatment (1 B+). The evidence supporting intra-articular corticosteroids is limited; hence, this should be reserved for those individuals who do not respond to radiofrequency treatment (2 B±).
van Kleef
Maarten
M
Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands. maarten.van.kleef@mumc.nl
Vanelderen
Pascal
P
Cohen
Steven P
SP
Lataster
Arno
A
Van Zundert
Jan
J
Mekhail
Nagy
N
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D007270:Injections, Intra-Articular; D008159:Lumbar Vertebrae / Q000473:pathology*; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management; D010147:Pain Measurement; D021801:Zygapophyseal Joint / Q000294:innervation* / Q000503:physiopathology
D000305:Adrenal Cortex Hormones