Mark Wang, M.D. - Desert Institute for Spine CareMark Wang, M.D. - Desert Institute for Spine Care

12 Facet Joint Syndrome Pain Treatments

By Mark Wang, MD

Dr. Mark Wang is a fellowship-trained and board-certified orthopedic spine surgeon. Dr. Wang dedicates his full attention to working together with his patients to identify their pain source and find the least invasive treatment that works for them.

June 10, 2022

One of the most common causes of neck and back pain is facet joint syndrome. Facet joints make up important parts of the skeletal system that support the spine and help people move, bend, turn and twist. Various factors such as aging, obesity, poor posture and spinal injuries can cause facet joints to degenerate over time.

Facet joint syndrome causes symptoms such as inflammation and pain, which affect movement and the ability to continue with normal daily routines. Facet joint syndrome cannot be reversed, but simple home therapies, as well as innovative non-surgical and surgical procedures, can help alleviate pain and improve a patient’s quality of life.

If you experience back pain, facet joint syndrome may be causing your discomfort. An experienced physician can evaluate the cause of your pain and recommend a facet joint treatment method based on your condition.

What Are the Causes and Symptoms of Facet Joint Syndrome?

According to the Centers for Disease Control and Prevention (CDC), lower back pain causes more disability worldwide than any other condition. Acute back pain typically lasts less than four weeks, and chronic back pain persists longer than 12 weeks. Facet joint syndrome can cause both acute and chronic back pain. 

A chain of connected and moveable bones known as vertebrae make up the spine. The spine is able to bend and twist while the bones remain linked together because each vertebra contains a disc and two facet joints above it to form a three-joint complex. Facet joints contain synovial fluid lubrication, cartilage lining and a joint capsule cover. This allows them to slide, glide and prevent over-twisting as the spine bends and moves. 

Facet joint syndrome is an arthritis-like spine condition that causes pain in one or more facet joints. When degenerative changes occur in the spine, it can cause body weight to unevenly shift and place more pressure on the facet joints. The additional pressure causes wear and tear on the joints, and as a result, the following occurs over time:

  • Joint capsules become thin.
  • Smooth cartilage gradually breaks down.
  • Bone spurs can develop.

As the joints undergo these changes, they fail to move fluidly, and they become irritated and inflamed. Pain signals travel from the joint’s sensory nerves to the brain, and this can cause discomfort as well as muscle spasms and stiffness. 

Facet joint syndrome may be painless until something triggers pain, but the pain can also be chronic. If any of your facet joints are damaged or degenerating, you will typically feel pain when you twist in the direction of the damaged joint or bend backward. You may also feel pain when you stand or sit still for some time. Leaning forward, sitting in certain positions or changing positions may temporarily ease the discomfort.

This spine condition usually causes a dull pain or ache that occurs over the spine in the lower back and extends to the buttocks, or it can cause pain at the base of the skull and in the shoulders. If bone spurs develop and place pressure on spinal nerves, pain can also extend down the legs or arms. Lumbar facet joints cause 14%-41% of lower back pain, which is the most common pain syndrome. 

People typically develop facet joint syndrome between the ages of 40 and 70. However, it is more common in adults over 50 years old. A spine injury, whiplash, genetics, poor posture, obesity, repetitive movements and various spine conditions can also increase the likelihood of developing the syndrome.

Facet Joint Syndrome Diagnosis

The pain that comes with facet joint syndrome can mimic other spine conditions, so a physician will carefully evaluate your condition to determine the source of your pain and make a diagnosis. To accurately diagnose facet joint syndrome, your doctor will consider the following factors:

  • Your medical history
  • Physical exam results
  • History of injuries
  • Any problems sleeping or standing
  • Pain location

If your doctor suspects you may have facet joint syndrome, they may ask you to move or stand in various positions and indicate where you feel pain. They may also feel for tender spots on your spine and work your joints to determine where the damaged facet joints may be located. 

Once your doctor has a general idea of where your pain is coming from, they may order imaging studies to support their diagnosis and rule out any other spine-related conditions. An MRI, CT scan or X-ray provides a clear image of the spine so your physician can locate the damaged facet joints. 

12 Facet Joint Syndrome Treatment Options

Facet joint syndrome can complicate daily life due to pain and discomfort. However, there are some treatment methods that can relieve or eliminate pain to help you live more comfortably. Some patients experience pain relief with nonsurgical treatment methods, while others need to undergo a surgical procedure to achieve pain relief. 

The facet syndrome treatment method that’s best for you will depend on your condition and pain level, and a doctor can determine the proper treatments and procedures for you to try. 

Non-surgical Options

If you develop facet joint syndrome and experience pain, you may be able to alleviate your discomfort with some at-home remedies or non-surgical medical procedures. Your doctor may recommend any of the following pain management treatment options:

1. Heat and Cold Therapy

Heat and cold therapy can help ease pain caused by facet joint syndrome. Heat boosts circulation, relaxes muscles and dilates blood vessels, while cold can constrict blood vessels to reduce swelling. When you apply heat, it allows more oxygen and blood to nourish tissues. You can use heat therapy throughout the day or try it when you wake up each day to relieve stiffness and pain. 

Cold therapy typically works best when you experience acute pain or have a flare-up. Placing a cold pack on the affected area for no more than 20 minutes at a time can restrict blood vessels to reduce blood flow to numb the pain. 

Both methods can alter pain sensations, and they can be used together or separately. You can try cold gel packs, heat patches, heating pads, hot water bags and warm baths to find which method or combination works best for you. 

2. Medications

Some patients with facet joint syndrome take medications to alleviate back or neck pain. The medication that’s right for you may depend on your pain level, any medications you’re currently taking and how you react to different types of medication. Helpful medications can include any of the following:

  • Oral anti-inflammatory medications
  • Topical creams or salves
  • Topical patches
  • Muscle relaxers

Your doctor can recommend specific medications and treatments, taking into account your medical status.

3. Physical Therapy and Exercise

Exercise can help ease facet joint pain and speed the healing process. A physical therapist can instruct you on stretching and strengthening routines as well as proper walking and lifting techniques. They will help you learn how to properly stretch your leg, stomach and lower back muscles, and you can use what you learn to continue exercising on your own to aid your healing process and alleviate pain.

It’s important to consult with your doctor before beginning an exercise regimen. An experienced physician will be able to tell you how much physical activity is safe for your body and its condition. 

4. Proper Posture

It’s important to keep your spine in its proper alignment to reduce or prevent pain. Keep a correct posture by keeping your spine straight, and avoid slouching or slumping. 

If you work at a desk, try to sit in a swivel chair that has a straight back and armrests. You may need to adjust your sleeping position to avoid compromising your posture overnight. You can also reduce pressure on your facet joints and reduce pain by losing weight and strengthening your core, which can benefit posture. 

5. Back Brace

A mechanical back brace can help you to keep your back straight while standing and sitting. It can also limit twisting, bending and micro-motions and decrease pressure on the facet joints. It’s important to consult with a doctor before using a back brace because some situations may require alternative or additional treatment methods. A doctor will also recommend the correct type of back brace and instruct you on the proper way to wear it.

6. Epidural Steroid Facet Injections

Physicians can use epidural injections to both diagnose facet joint syndrome and ease pain caused by the condition. This injection method uses either steroids or a combination of steroids and anesthetics. 

When either of these injection types is used to diagnose facet joint syndrome and locate pain points, the diagnostic injection includes an anesthetic. The anesthetic helps locate the affected facet joints or medial branch nerves.

Synovial membrane tissue makes up joint capsules that surround facet joints. Each joint capsule’s upper pad is fused with the spinal nerve’s fatty sheath, and the capsule contains nerves that send signals to the brain. When a joint capsule’s synovial membrane is inflamed, facet joint injections can reduce pain in the following ways:

  • Reducing pain receptor sensitivity to decrease pain signals to the brain
  • Hindering inflammatory chemical production

If several facet joints are producing pain, your physician may deliver more than one injection to target each affected facet joint. The success rate of facet joint arthritis treatment injections can vary from person to person. Some patients experience short-term pain relief, while others experience long-term pain relief or find that their pain completely dissipates. 

Patients who experience short-term relief can use their time without pain to work on physical therapy until they need to receive repeat injections. Improving flexibility and strength can increase the chances that injections lead to long-term pain relief. 

7. Medial Branch Injections

Medial branch nerves extend from each spinal nerve’s dorsal rami, and they mainly have sensory properties with which they supply the facet joints. When a person receives injections near their branch nerves, it can reduce pain in the following ways:

  • Decreasing nerve fiber permeability to reduce the blood each nerve receives
  • Suppressing pain signals from the nerve
  • Blocking C fibers to reduce pain transmission to the brain

For both facet joint injections and medial branch injections, the doctor will use ultrasound or fluoroscopy to deliver the needle to the correct area. 

Surgical Options

When non-surgical pain treatment methods are unsuccessful, you may need to consider surgical pain management options. While surgery cannot reverse facet joint syndrome, it can help reduce or eliminate pain and improve your quality of life. Your doctor can evaluate your situation and recommend one of the following surgeries based on your condition:

1. Lumbar Spinal Fusion

Lumbar spinal fusion surgery is a minimally invasive treatment for facet arthropathy that can reduce pain, nerve damage and spinal pressure. During this procedure, a surgeon fuses vertebrae in the lower back together to eliminate the motion between them. 

This procedure can help alleviate the symptoms of facet joint syndrome, but it does not eliminate the condition. It’s important that patients follow their doctor’s recommendations for physical therapy and live a healthy lifestyle to maintain positive results following the surgery. 

2. Laminectomy

During a laminectomy surgery, which is also known as lumbar decompression, a surgeon will remove the back of a vertebra. A doctor will typically recommend this surgery if the patient’s condition could lead to spondylolisthesis. Spondylolisthesis causes a vertebra to slide over the vertebra underneath it and can potentially compress the spinal cord or spinal nerves. Lumbar decompression decreases compression by creating space for neural tissues. 

3. Facetectomy

If a patient has bone spurs in their facet joints, a surgeon can perform a facetectomy to remove excess bone by trimming part of the affected facet joint. Bone spurs can impact the spinal cord and spinal nerves, so the purpose of a facetectomy is to remove the spurs and protect the spinal cord and nerves from damage.

4. Nerve Ablation

A nerve ablation procedure or Endoscopic Rhizotomy cauterizes and disconnects the nerves that deliver pain signals to the facet joints. During a facet nerve ablation, a surgeon under direct visualization via a endoscope will use a laser or bipolar radiofrequency energy to cauterize the medial branch nerves in the affected area. They essentially burn the nerves and disconnect them so they can no longer deliver pain signals. 

Rather than eliminating the condition, nerve ablation eliminates the pain caused by facet joint syndrome. Patients experience long-term pain relief (up to 5 years) after receiving this procedure.

5. Discectomy

A discectomy can restore strength and reduce pain. During this procedure, a surgeon will remove any damaged parts of a disc to prevent it from compressing the nerves around a facet joint. A doctor will recommend this surgery if a damaged disc is causing pain. 

Find Facet Joint Pain Relief at the Desert Institute for Spine Care

Facet joint syndrome causes wear on the spine over time, but it is still possible to live a comfortable life with minimal or no back pain. Various at-home treatments, physical therapy and nonsurgical medical procedures can help alleviate the pain that comes with facet joint syndrome. If these remedies are unsuccessful, you can talk to a qualified physician about surgical treatment options for facet syndrome. 

The Desert Institute for Spine Care (DISC) offers highly advanced treatment options, including nonsurgical procedures, least-invasive surgeries and minimally invasive surgeries. Our board-certified surgeons have over 50 collective years of experience in patient care, and we will care for you with the least invasive treatment options to help restore your lifestyle. Contact us to learn more about how we can help you relieve back pain and live life more comfortably. 

LEADERS IN MINIMALLY INVASIVE SPINE CARE
1635 E. Myrtle • Suite 400 • Phoenix, AZ 85020
Ph: 602-944-2900 • Fax: 602-944-0064

DISC - Desert Institute for Spine Care
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