Low back pain is incredibly common in Australia. Most people who experience back pain will improve with simple medications, rest and then gently restarting activity. In some cases, unfortunately people develop chronic low back pain – pain which lasts greater than three months. This back pain can be very frustrating, can stop us doing the things we enjoy, and even affect things like our mood and ability to work.
Most back pain involves pain coming from many structures such as the ligaments, tendons, muscles, discs and joints. The best treatment if all these things are causing pain, is physical therapy and movement. We say, ‘motion is lotion’. Muscles and our bodies were designed to move and if they don’t, they start to hurt. Unfortunately, in some cases people are too sore or have become too deconditioned to be able to participate in rehabilitation. In these cases, it is sometimes possible to try and reduce/dampen one or several of these areas which are causing pain.
Your facet joints are small joints on the back of every backbone (vertebrae). 60% of your weight is supported by the discs in our spine, however 40% or more of our weight is placed through small joints at the back of the bone called facet joints. Just like developing osteoarthritis of the knee or hip, you can develop osteoarthritis of these joints or even sprain them like spraining an ankle. Unfortunately, unlike a knee or hip, we cannot replace this joint to remove the discomfort.
So how do we work out if your back pain is coming from your facet joints? Well, most people will describe it as an aching or tooth ache pain in the back – but some people may describe sharp or stabbing feelings. Some people may have pain when we press on different areas of their back, other people may not. Some people have pain when they bend backwards – putting pressure on the facet joints. But in other people – even this doesn’t conclusively confirm facet problems.
There is a picture below showing the range of possible areas of pain which can be coming from the facet joints. As pain physicians, one procedure we can perform to work out if the facets are causing pain, is called a ‘diagnostic block’. We use local anaesthetic (the same medication used for removing skin lesions, numbing cuts for stitches, or for having a dental filling) and under either X-ray or Ultrasound vision, we place local anaesthetic on the small nerve (or wire) that connects to the facet joint.
If we numb that nerve, and then you feel your pain is significantly reduced or gone, then we can work out how much of your pain is coming from your facets versus other structures. The procedure is quick (10-20 mins), done under mild sedation (so you are sleeping but not having an anaesthetic tube (full anaesthetic) and the needles used are not much larger than acupuncture needles.
So, if it is your facets contributing to your pain, what can we do next? Well, if someone has a positive diagnostic block (meaning most of their pain was significantly reduced for 4-6 hours in that area) then we can do a second longer procedure another day. We use slightly larger needles and either heat, or small pulses of electrical activity (while you are asleep) to attempt to settle your pain for longer (6-12 months).
Does this fix the facet joint? No. But neither is that the goal. The goal of the procedure is to reduce your pain so we can try and get you back to as much of your life as possible. If you can perform rehabilitation exercises, you may be able to strengthen all the local muscles, ligaments and other tissues which are likely worsening your pain. So, if the procedure wears off, our hope is if you have done the rehabilitation work, your pain may come back much less or not come back at all.
If your pain did come back the procedure can be safely repeated if required and some people find this helps to manage their pain ongoing. Some people prefer having a procedure approximately once a year rather than taking tablets every day.
Will this take away all your pain? On its own, no. Remember you still have other tendons, ligaments, muscles etc. which you may not have been using properly due to your pain. Hopefully your pain will be down sufficiently that you can then take active control of your rehabilitation and hopefully improve your strength and reduce your pain.
If you would like to know more, or to book, please contact our rooms and we can help with the appropriate organising steps. We have other information regarding diagnostic blocks and radiofrequency ablation which your doctor may provide, or you can ask for from reception.
Please be aware this video is not created by Resolve Pain and this is an external link - the information provided is for general information only and we recommend discussing any questions you have with your doctors and health team.