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10 - Facet (Zygapophyseal) Joint Injections

from PART I - LOCOREGIONAL PAIN CONTROL

Published online by Cambridge University Press:  04 September 2009

By
Nick Stence
Edited by
Charles E. Ray, Jr.
Charles E. Ray, Jr.
Affiliation:
Denver Health Medical Center
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Summary

INTRODUCTION

Back pain due to the many causes is a significant health issue in this country. The annual incidence of lower back pain is at least 5% (1). It affects men and women equally, most often between 30 and 50 years of age. About 85% of patients with isolated back pain cannot be given a diagnosis (2). Finding an association between imaging findings and symptoms is usually difficult or, at times, impossible (1,3).

Given the prevalence of back pain, therapies and interventions treating such processes represent a growing segment of health care spending. For example, spinal injection procedures have expanded significantly since the mid- to late 1990s. The volume of facet joint injections has almost tripled and reimbursements have followed the same trend. The provider profile has changed as well, with anesthesiologists performing the majority of procedures and radiologists share of procedures declining from 1993 to 1999 (4).

Chronic low-back pain is defined as pain persisting longer than three months. Most monotherapies (e.g., analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants, antidepressants) do not work or have limited efficacy for chronic low-back pain (2). Facet joint pain is thought to be a significant cause of otherwise unexplained chronic low-back pain. In the group of chronic low-back pain patients for whom conventional investigations do not identify a cause of pain, facet joint pain can be diagnosed by facet injections with local anesthetic in 15–40% of patients (5).

Therapy for facet joint pain remains somewhat controversial.

Type
Chapter
Information
Pain Management in Interventional Radiology , pp. 151 - 163
Publisher: Cambridge University Press
Print publication year: 2008

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References

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