One of the least liked phenomena associated with getting older is arthritis. The spine is not excluded from arthritis, as each level of the spine has two facet joints which contain cartilage just like the hip or the knee.
Each set of facet joints contributes immensely to a person’s spinal range of motion, so if arthritis sets in then the person may experience chronic daily back pain due to the problem. Along with physical therapy, chiropractic treatment and medications, what are the best interventional treatments that pain management doctors offer for relief from spinal arthritis?
Here is a description of the top four procedures.
1. Facet injections – These injections are similar to joints like the hip or the knee, where cortisone is injected directly into the arthritic joint. There are some studies showing moderate benefit from these intra-articular injections.
However, the facet joints are very small, around the size of a thumbnail, and it may be difficult for the pain doctor to achieve entry, especially when the joint is arthritic and overgrown with excess bone and soft tissue.
Most pain doctors utilize fluoroscopy, which is a real-time form of x-ray and helps to improve accuracy. These injections may be given every few months for pain relief. The duration of pain relief received from facet injections ranges anywhere from a few days to 3 to 6 months.
2. Medial branch blocks – The medial branches are small nerve endings that come off of nerve roots. They do not have any motor function at all, and what they really do is bring sensation to the spinal joints. In order to feel pain, arthric joints have to have a nerve supply, which is predominately from the medial branches. A medial branch block is an outpatient procedure that involves injecting numbing medicine and sometimes steroid around the area of these nerve endings.
The injection does not go into the joint itself, rather, it goes around it into places where the medial branch nerve endings come into the joint.
These injections work very well to tell the pain doctor if that joint is a source of a person’s pain. It also works well for pain relief itself, studies show that medial branch blocks provide on average 3 to 4 months of pain relief.
If the injection works well and then subsequently wears off, the pain management doctor can either repeat the injection or move on to a radiofrequency ablation.
3. Radiofrequency ablation – This procedure has been one of the most revolutionary technological advancements for pain management in the 21st century. Essentially what the procedure is doing is applying thermal radiofrequency energy to the medial branch nerve endings and deadening them from anywhere
from six months to two years. The pain relief received from radiofrequency ablation may be tremendous and eventually the small nerve endings may grow back. At that point, the RFA may be repeated with the expectation that additional excellent results will be received.
Radiofrequency ablation procedures are also known as medial branch neurotomy, radiofrequency neurotomy, medial branch rhizotomy or RFA.
There really has not been a procedure developed yet that has such lengthy pain relief for facet arthritis than a radiofrequency ablation. Because of that, it is commonly used for chronic back or neck pain, along with different techniques of it for SI joint pain, migraine headaches and pelvic or abdominal pain.
4. Regenerative Medicine Injections – I mention these last but not least because they have excellent potential as a future pain relief procedure for spondylarthritis. Basically all of the facet arthritis procedures today focus on relieving pain but not altering the course of the disease. Stem cell injections and platelet rich plasma offer the potential of some repair and regeneration of the joint damage. Studies are under way to evaluate the effectiveness of these procedures, time will tell if they become mainstream for the treatment of spinal arthritis.
It is good to know that for chronic neck and back pain, relief is available with these procedures. In conjunction, physical therapy, chiropractic treatment, spinal decompression therapy, acupuncture and medication management may drop a person’s pain levels into an area that is extremely manageable. If you suffer from chronic pain, help is available.
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