back pain, Facet joint radiofrequency denervation, neck pain

FACET JOINT RADIOFREQUENCY DENERVATION FOR NECK PAIN AND BACK PAIN

FACET JOINT

The spine is a column of bones arranged one on top of the other. The bones are linked at the back by joints called facet joints, one on each side. The facet joints hold the bones together and stabilise the spine, while also allowing movement.

The facet joints may become painful either due to wear and tear (also called degenerative change), stress or injury, although the reason is not always clear. Pain is felt around the facet joints and in the surrounding area. For example, pain starting from the joints of the lower back will often be felt in the buttocks and upper legs.

WHEN IS DENERVATION USED?

The denervation procedure is usually considered after trying less invasive treatments, such as medication, physiotherapy, transcutaneous nerve stimulation (TENS).

Exercise, acupuncture, yoga/pilates and relaxation therapy may also help ease back pain. Spine surgery could be also considered in selected cases.

Denervation is usually only considered if you have responded well to local anaesthetic injections near the affected areas, and these have helped to reduce pain.

WHAT IS THE FACET JOINT RADIOFREQUENCY DENERVATION

Facet joint radiofrequency denervation is a procedure in which nerve fibres supplying the painful facet joints are selectively destroyed by heat produced by radio waves and delivered through a needle.

The treatment is usually performed after an injection of a local anaesthetic close to the affected joints has helped to reduce feeling and pain.

The denervation treatment involves placing a special needle (radiofrequency probe) near the nerve of the joint; when a radiofrequency current is passed down the probe, a very small area of heat is created that causes a break in the nerve. This procedure does not affect any other part of the body. https://www.nice.org.uk/researchrecommendation/radiofrequency-denervation-what-is-the-clinical-and-cost-effectiveness-of-radiofrequency-denervation-for-chronic-low-back-pain-in-the-long-term

back pain, Lower back pain and spinal arthritis

TWO COMMONLY USED TREATMENTS FOR TREATING LOW BACK PAIN AND SCIATICA ARE NON-INVASIVE TREATMENT AND INVASIVE TREATMENTS.

Non-invasive treatments for low back pain and sciatica

The non-invasive treatments have two types, (a) non-pharmacological intervention and (b) pharmacological intervention.

(a) Non-pharmacological intervention includes:

(1) Self-management – self-management is advice and information tailored to individual needs and capabilities to help themselves self-manage their low back pain.

(2) Exercises – group exercise programme (aerobic, mind-body or a combination of approaches) for people with specific needs or flare-up of low back pain with or without sciatica.

(3) Manual therapies – manual therapy include spinal manipulation, mobilisation or soft tissue techniques such as massage for managing low back pain with or without sciatica, but only as part of a treatment package including exercise.

(b) Pharmacological intervention
Pharmacological intervention includes oral non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person’s risk factors, including age.

If NSAID is contraindicated or not tolerated or has been ineffective, weak opioids (with or without paracetamol) is usually considered for managing acute low back pain.

Invasive treatments for low back pain and sciatica

Invasive treatments have two types, (a) non-surgical interventions and (b) surgical interventions.

(a) Non-surgical interventions includes:

(1) Radiofrequency denervation

Referral for assessment for radiofrequency denervation for people with chronic low back pain has to be considered when non-surgical treatment has not worked for them and the main source of pain is thought to come from structures supplied by the medial branch nerve and they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral.

(2) Epidurals

Epidural injections of local anaesthetic and steroid are usually used in people with acute and severe sciatica and tend not to be used in people who have central spinal canal stenosis.

(b) Surgical Interventions

Most performed surgical interventions are spinal decompression, spinal fusion and disc replacement.

Spinal decompression is usually considered for people with sciatica when non-surgical treatment has not improved pain or function and their radiological findings are consistent with sciatic symptoms.

Spinal fusion is not usually offered to people with low back pain unless as part of a randomised controlled trial.