title: Mechano-transduction effect of shockwaves in the treatment of lumbar facet joint pain: comparative effectiveness evaluation of shockwave therapy, steroid injections and radiofrequency medial branch neurotomy.
abstract: OBJECTIVE
  Lumbar facet joints (FJ) is a common source of low back pain and contributes approximmately on one third of chronic low back pain. Medial branch radiofrequency neurotomy is considered as a gold standard in the treatment of facet joint pain. Corticosteroid injections have also presented effect in FJ pain. As an interventional procedures, they carry not-negligible risk of possible complications including infection, damage to nerve root or medial branch structures. Shockwave therapy (SWT) is a non-invasive method for treatment of various musculoskeletal disorders. Its effect is based on transduction of mechanical energy, transferred to cascade of various biochemical processes in target tissue. Its efficacy was proved in the treatment of different painful conditions. The efficacy of SWT was not yet studied in FJ pain. Aim of our work was to compare the efficacy of SWT against interventional treatment procedures - radiofrequency neurotomy and corticosteroid FJ injections.
  
  
  METHODS
  A retrospective study was done on 62 selected patients with unilateral chronic lumbar facet pain. There were 32 women and 30 men, divided into SWT group, corticosteroid injections group radiofrequency group. Nociceptive and neuropathic pain intensity and severity of pain were measured.
  
  
  RESULTS
  Shockwave therapy had shown better longterm results compared to FJ injections group and little inferior efficacy compared to RMBN. We did not observe any adverse effects and complications in SWT group. Moreover, in SWT and RMBN groups, significant longterm improvement in daily activities limitation, was observed.
  
  
  CONCLUSIONS
  SWT appears to be a safe and perspective option in the treatment of FJ pain with negligible side effects.
authors.affiliation: Charles University in Prague, 2nd Faculty of Medicine, Department of Neurology, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Nedelka
authors.affiliation: Center for Rehabilitation and Treatment of Spine Pain, Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Nedelka
authors.affiliation: Czech Technical University, Faculty of Biomedical Engineering, Kladno, Czech Republic.
authors.forename: Jakub
authors.initials: J
authors.lastname: Schlenker
authors.affiliation: Bridgeland Sport and Spine Center, Calgary, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hankins
authors.affiliation: Charles University in Prague, 2nd Faculty of Medicine, Department of Neurology, Prague, Czech Republic.
authors.forename: Radim
authors.initials: R
authors.lastname: Mazanec
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D003131:Combined Modality Therapy; D003714:Denervation / Q000379:methods*; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000294:innervation; D008297:Male; D040542:Mechanotransduction, Cellular / Q000502:physiology; D010865:Pilot Projects; D012189:Retrospective Studies; D014463:Ultrasonography; D021801:Zygapophyseal Joint / Q000187:drug effects / Q000294:innervation / Q000648:ultrastructure
chemical_list: D000305:Adrenal Cortex Hormones