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A skilled physical examination may be all that’s required to diagnose a problem with facet joints
It’s been aptly said, “They preach patience who never felt pain.”
Chronic severe pain can be soul-destroying, particularly when the diagnosis is not known.
One of the most troublesome categories is back and neck pain. It can render people immobile, making even the simplest activity a challenge. Because it involves the spine, and therefore a wide range of muscles, as well as the delicate and complex central nervous system, back and neck pain is also a worry due to the risks of treatments that go wrong.
Unfortunately, all too often, the diagnosis and treatment of spinal problems involves expensive tests, risky surgical procedures and powerful drugs. But as regular readers will know, I have always been loath to recommend surgeries and pharmaceutical drugs when there are other options. Instead, if you suffer from relentless back or neck pain, you might be wise to see a physician who practices alternative or integrative medicine. A skilled physical examination may be all that’s required to diagnose a problem with your facet joints.
Facet joints connect the bones of the spine and help to guide them as they move. They’re found on both sides of the spinal cord, and each one is about the size of a thumbnail. If they’re injured or become inflamed due to wear and tear, they can cause muscle pain or severe neck pain that can be difficult to diagnose.
Through spine manipulation, and without the use of X-rays and MRIs, specialists can determine the location of the specific facet joint that due to age or injury has become the source of pain. Treatment involves injection of an anesthetic, along with a steroid, into the facet joint. This is not an easy task. It takes a combination of sensitive fingers, practice and skill.
Patients can expect a series of visits to the doctor’s office for several injections of the steroid medication over the course of days or weeks. One objective is to provide enough pain relief to enable physiotherapy to proceed. Another objective is to determine if the injection alone resolves the pain, or if additional treatments are required. Results depend on the degree of injury, the severity of inflammation and the effectiveness of physiotherapy.
If the pain cannot be eradicated for longer periods by repeated injections, the next step could be a treatment called cervical radiofrequency ablation (RFA). This procedure uses heat generated from radiofrequency energy to destroy nerve function, stopping the nerve from transmitting pain signals to the brain. RFA uses fluoroscopy to ensure safe and proper position of the needle.
Following RFA treatment, cervical neck pain may not return. But there is always the possibility that the nerve will regenerate and require further RFA. As I have often advised, when agreeing to a surgical procedure, nothing can be guaranteed.
Doctors trained in conventional medicine may not direct patients to explore facet joint injection as a potential treatment for back and neck pain. The common approach is to order x-rays, CT scans, and MRIs. But all patients should be informed by their doctors that they have choices. Expensive tests have a role, but they are not always the right answer. And potent painkillers by prescription should be the last resort, not the first, as they can have many negative effects.
Many people suffer through back and neck pain without resolution. But if this is the first time you have heard about facet joint treatment, you may wish to ask your doctor for more information. And if your doctor scoffs at alternative medicine, that’s a good time to find a new doctor. When caring for your health, as the old saying goes, “It’s better late than never.”
Dr. W. Gifford-Jones is a syndicated columnist whose medical column appears in The Guardian every Tuesday. Check out his website, docgiff.com, which provides easy access to past columns and medical tips. For comments, readers are invited to email him at firstname.lastname@example.org. He can also be found on Twitter @GiffordJonesMD.