Are your facet joints caus­ing you pain?

Lodi News-Sentinel - - LOCAL/NATION - Dr. Ken Walker (W. Gif­ford-Jones, MD) is a grad­u­ate of the Univer­sity of Toronto and the Har­vard Med­i­cal School. He trained in gen­eral surgery at the Strong Me­mo­rial Hos­pi­tal, Univer­sity of Rochester, Mon­treal Gen­eral Hos­pi­tal, McGill Univer­sity and in Gy

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.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.