title: Facet joint pain--advances in patient selection and treatment.
abstract: Facetogenic pain, also known as zygapophysial joint pain, is a frequent cause of mechanical spine pain. Diagnostic blocks (for example, medial branch blocks [MBBs]) are the only reliable approach to identify facet joints as the source of neck or back pain. In the absence of a reference standard, MBBs actually serve more of a prognostic than diagnostic role, enabling the selection of patients who might respond to radiofrequency denervation treatment--the standard treatment for facet joint pain. Using double blocks reduces the false-positive rate of MBBs, but will invariably reduce the overall treatment success rate. No studies have evaluated non-interventional treatments for confirmed facetogenic pain, but data from studies in non-specific back pain suggest a modest, short-term beneficial effect for pharmacotherapy and some non-traditional treatments. Trials of intra-articular steroid injections for lumbar and cervical facet joint pain have yielded disappointing results, but evidence suggests that a subpopulation of patients with acute inflammation derive intermediate-term benefit from this therapy. Radiofrequency denervation provides some benefit for up to a year in approximately 60% of individuals. Increasing this success rate might involve enhancing diagnostic specificity and phenotyping, as well as techniques that increase the likelihood of successful nerve ablation, such as maximizing lesion size.
authors.affiliation: Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, 550 North Broadway, Suite 301, Baltimore, MD 21029, USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Julie H Y
authors.initials: JH
authors.lastname: Huang
authors.forename: Chad
authors.initials: C
authors.lastname: Brummett
mesh_terms: D018771:Arthralgia / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods; D003714:Denervation / Q000379:methods; D019468:Disease Management; D006801:Humans; D007270:Injections, Intra-Articular; D018579:Patient Selection; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D021801:Zygapophyseal Joint
chemical_list: D013256:Steroids