title: Intra-articular facet joint injections for low back pain: a systematic review.
abstract: OBJECTIVE
  Evidence supporting the use of therapeutic intra-articular facet joint injections for patients with suspected facet joint pain is sparse. A systematic review including a narrative synthesis was carried out to determine if intra-articular facet joint injections with active drug are more effective in reducing back pain and back pain-related disability than a sham procedure or a placebo/inactive injection. Secondly, to determine if intra-articular facet joint injections with active drug or placebo/inactive injection are more effective in reducing back pain and back pain-related disability than conservative treatment.
  
  
  METHODS
  Medline, EMBASE, CINAHL, CENTRAL, Index to Chiropractic Literature and the Cochrane Central Register of Controlled Trials were searched from inception through April 2015. Data were screened and single extraction with independent verification and risk of bias assessment was performed.
  
  
  RESULTS
  A total of 391 records were screened, and six trials were included. The trials included were small (range 18-109 participants) and overall in terms of pain and disability outcomes most were inconclusive. Only two of the trials report any significant between-group differences in pain (mean difference -1.0, 95% CI -2.0 to -0.1) and (p = 0.032) or disability (mean difference -3.0, 95% CI -6.2 to 0.2) and (p = 0.013) outcomes.
  
  
  CONCLUSIONS
  The studies found here were clinically diverse and precluded any meta-analysis. A number of methodological issues were identified. The positive results, whilst interpreted with caution, do suggest that there is a need for further high-quality work in this area.
authors.affiliation: Warwick Medical School, The University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors.forename: Rajni
authors.initials: R
authors.lastname: Vekaria
authors.affiliation: Warwick Medical School, The University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors.forename: Ree'thee
authors.initials: R
authors.lastname: Bhatt
authors.affiliation: Warwick Clinical Trials Unit, The University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. d.r.ellard@warwick.ac.uk.
authors.forename: David R
authors.identifier: http://orcid.org/0000-0002-2992-048X
authors.initials: DR
authors.lastname: Ellard
authors.affiliation: Institute for Public Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Henschke
authors.affiliation: Warwick Clinical Trials Unit, The University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Underwood
authors.affiliation: Warwick Clinical Trials Unit, The University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
authors.forename: Harbinder
authors.initials: H
authors.lastname: Sandhu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D017116:Low Back Pain / Q000188:drug therapy*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Disability; Intra-articular facet joint injections; Low back pain; Systematic review