Effect of facet joint injection versus systemic steroids in low back pain: a randomized controlled trial.
METHODS
Randomized clinical trial.


OBJECTIVE
To compare the effectiveness of facet joint injection versus systemic steroid in patients with a diagnosis of facet joint syndrome.


BACKGROUND
The term facet joint syndrome has been used to define back pain originating from the facet joints. Treatment is mainly conservative, although interventions, including intra-articular injections and medial branch nerve blocks are used to manage facet-mediated pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting.


METHODS
Sixty subjects with a diagnosis of facet joint syndrome were enrolled in the study. They were randomized into experimental and control groups. The experimental group was administered with intra-articular injection of 6 lumbar facet joints with triamcinolone hexacetonide; the control group was administered with triamcinolone acetonide intramuscular injection of 6 lumbar paravertebral points. Visits were taken at baseline and at 1, 4, 12, and 24 weeks after interventions. Outcome measures were used: pain visual analogue scale, pain visual analogue scale during extension of the spine, Likert scale, improvement percentage scale, Roland-Morris, 36-Item Short Form Health Survey, and accountability of medications taken.Homogeneity was tested using the Student t, Pearson χ, and Mann-Whitney tests. Analysis of variance was used to analyze differences in the groups over time and the Student t test to analyze differences between groups at each time evaluation.


RESULTS
The groups were similar at baseline. Comparisons between the groups showed, in analysis of variance analysis, an improvement in the experimental group regarding diclofenac intake and quality of life, in the "role physical" profile, assessed by 36-Item Short Form Health Survey.In the analysis at each time point, an improvement in the experimental group was also found in the Roland-Morris questionnaire, in the improvement percentage scale and in the response to treatment, assessed by the Likert scale.


CONCLUSIONS
Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.
From the Division of Rheumatology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Luiza Helena
LH
Ribeiro
Rita Nely Vilar
RN
Furtado
Monique Sayuri
MS
Konai
Ana Beatriz
AB
Andreo
Andre
A
Rosenfeld
Jamil
J
Natour
D000368:Aged; D001938:Brazil; D016009:Chi-Square Distribution; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007273:Injections, Intramuscular; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D021801:Zygapophyseal Joint / Q000187:drug effects* / Q000503:physiopathology
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide