Back Pain Caused by Arthritis in Facet Joints Treatable With Nonsurgical, Minimally Invasive Procedures

When it comes to chronic back pain, the cause can sometimes be difficult to parse out, says Michael Grimaldi, MD, pain medicine physician with Lehigh Valley Orthopedic Institute and LVPG Pain Specialists–Carbon. 

“There are a multitude of possible causes of this common condition,” Grimaldi says. “As people age, they can get arthritis in the facet joints, small joints located at the posterior part of the spine. If we suspect that a patient’s chronic back pain is stemming from arthritis in this joint, we can do a medial branch block to confirm whether this is the case.”  

After injecting local anesthetic under fluoroscopic guidance, pain management specialists assess the extent of the person’s pain relief from the block, which typically lasts around six hours.

“If pain is coming from those facet joints, we expect a significant improvement in the patient’s pain when they’re numbed up by the medial branch block,” Grimaldi says.

If facet joint arthritis is indeed the cause, rhizotomy, or radiofrequency ablation, can be performed to provide longer-lasting pain relief. Using heat energy, the procedure “cooks” the small nerves that supply sensation to the joint, temporarily destroying and
blocking them from transmitting pain signals.

“Medial branch blocks are very quick and can be done easily in an office setting – same with radiofrequency ablation,” Grimaldi adds.

Rhizotomy, a relatively new pain management technique, requires great precision through visualization due to placement of the needle that contains a radiofrequency probe, also achieved through fluoroscopic guidance.

These peripheral nerves will eventually grow back, allowing the chronic pain to resurface. However, rhizotomy can be repeated when the pain returns.

“Typically, we expect radiofrequency ablation to relieve pain for at least six months, usually, closer to nine to 12 months, sometimes even longer,” Grimaldi says.

Since most problems with facet joints are degenerative, aging individuals undergoing medial branch blocks and radiofrequency ablation are experiencing typical wear and tear of the joint, as are younger people who are physically active or work a physically demanding job, Grimaldi says. He also notes the procedures are not limited to the facet joints of the lower back.

“We also use radiofrequency ablation in the neck, so the cervical spine, as well as the thoracic spine and knee joint, can all be treated with the approach,” he says, particularly when traditional, conservative treatments like acetaminophen and anti-inflammatory medications, physical therapy and chiropractic care fail to provide relief. Plus, since it’s procedural, people are able to avoid adverse side effects of medication.

“It’s a good minimally invasive treatment that has minimal risks and minimal side effects, and can really help improve chronic pain and quality of life,” Grimaldi says.