Pain Management Content Related to facet.

Medial Branch Nerve Blocks

Tuesday, November 11th, 2008

Medial branch nerve blocks are a diagnostic test for facet joint arthropathy.  This test can be done in the cervical, thoracic, and lumbar spines.  I perform this procedure under intermittent X-ray guidance to localize the exact area of the nerve.  Each facet joint has two nerves that supply it.  By performing a local anesthetic block, facet arthropathy can be diagnosed or excluded.  After the injection, facet-loading maneuvers are performed.  In the low back, I have the patient bend back at the waist and to the affected side.  In the neck, this is done by the patient laterally flexing the neck (touching the ear to the shoulder).  If the pain is absent after the block, a diagnosis can be made.  This normally will only result in short-term relief.  However, with this information, radiofrequency ablation of these nerves can now be performed.  That will result in long-term relief.

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Facet Joint Arthropathy

Tuesday, November 11th, 2008

Facet arthropathy can affect the cervical, thoracic, and/or lumbar spine.  These small joints, also known as z-joints or zygapophysial joints, can be affected acutely or damaged from chronic wear and tear.  In the low back, these joints can be loaded or stressed by extension and lateral rotation (bending back at the waist and to one side).  If your usual pain is reproduced when making this motion without any leg pain, this is likely pain from your facet joints.  Pain can sometimes radiate to the buttocks and/or thigh, but rarely below the knee. 


In the neck, facet pain is reproduced when laterally flexing the neck (trying to touch your ear to your shoulder), as well as extending the neck (looking upwards).


Each individual joint has two nerves that supply it called medial branches.  These nerves are important in the treatment of facet-mediated pain.  This treatment involves medial branch nerve blocks and radiofrequency nerve ablation.


X-rays and MRIs can sometimes be helpful in diagnosing facet pain, but physical exam and diagnostic medial branch nerve blocks are most accurate.

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Low Back Pain

Saturday, August 30th, 2008

 The most common problem I see in my office is low back pain.  It affects the lives of 15-20% of adults and is the most common cause of disability in the United States.  Most cases of low back pain are related to muscle strain, sprain, and spasm which normally resolve with conservative management.  Other causes of chronic low back pain are more difficult to treat. These include:


            Discogenic pain (pain directly from disc disease)

            Sacroiliac Joint Arthropathy (back of the hip)

            Lumbar Facet Joint Arthropathy (small joints of spine)

            Spinal Stenosis (narrowing of spinal canal)

Lumbar Radiculopathy (nerve root irritation) with leg pain as well

Myofascial Pain (muscular pain)

Lumbar Post-Laminectomy Syndrome (failed back surgery)


Other rare causes of back pain include infection, tumor, pancreatitis, kidney stones, and sickle cell crisis.

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