23 dezembro, 2007

Treatment options for facet joint pain

To break up a cycle of recurring, acute facet joint pain, a number of treatments can be used successfully. Many of these treatments give some or even a lot of temporary relief but all too often, little long-term help.

There are a number of conservative care treatment options that can be tried to alleviate the pain and rehabilitate the back, such as:

Successful long-term treatment involves proper exercises, with instruction by a trained physical therapist or other healthcare provider.

Good posture (maintaining a normal curvature of the spine such as pulling the car seat quite forward or when standing at a sink, putting one foot up on a ledge, bending that knee a bit), support to the low back when seated or riding in a car (particularly in the acute phase). A very useful posture when standing or sitting is the pelvic tilt - where one pinches together the buttocks and rotates forward the lower pelvis - and holding that position for several seconds, done several times per day.

Heat (e.g. heat wraps, a hot water bottle, hot showers) or cold (e.g. cold pad applications) may help alleviate painful episodes.

Changes in daily activities (e.g. shortening or eliminating a long daily commute), and adding frequent rest breaks.

The use of anti-inflammatory medication, such as various non-steroidal anti-inflammatories, called NSAID’s (e.g. ibuprofen) and the more recent Cox-2 inhibitors (e.g. Celebrex).

Osteopathic manipulations may provide pain relief.

For the neck, a restraining collar may bring temporary relief, as may also cervical traction. A suitable supportive neck pillow is often essential and abnormal nighttime flexion positioning of the neck, such as when using a pile of pillows, is to be avoided.

More lasting relief of the facet joint problem can be obtained by destroying some of the tiny nerve endings serving the joints. This can be accomplished by a tip freezing or an electrified hot probe technique (also known as a facet rhizotomy) performed under careful x-ray control, (or for a lesser time by a carefully controlled injection of botox toxin which treats the muscle spasm).

In unusually severe and persistent problems, degeneration of the adjoining disc is nearly always present so the segment may require a bone fusion surgery to stop both the associated disc and facet joint problems. Such surgery may be considered radical, but an untreated persistent, episodic, severely disabling back pain problem can easily ruin the active life of a patient and surgery can therefore be a reasonable choice in selected cases.
Fortunately, for the vast majority of patients, a combination of change in life style, medication and proper exercise and posture will reduce the problem to a manageable level.

1. Ray CD: Facet syndrome: pathophysiology, clinical picture and treatment. Giornale Internationale per Terapia Antalgica 1:80-94, 1991.
2. Ray CD: Lumbar Facet Syndrome: Diagnosis and treatment by a percutaneous radiofrequency coagulation technique: revised methodology. Neurosurgical Quarterly, 9:209-231, Sept. 1999.

17 dezembro, 2007

Conservative treatment options for a cervical herniated disc

In addition to anti-inflammatory medications, there are a number of non-surgical treatment options that can help alleviate the pain from a cervical herniated disk, such as:
Physical therapy and exercise. Just as in the lumbar spine, Mckenzie exercises can be used to help reduce the pain in the arm. In the initial period a physical therapist may also opt to use modalities, such as heat/ice or ultrasound, to help reduce muscle spasm.
Cervical traction. Traction on the head can help reduce pressure over the nerve root. It does not work for everyone but is easy to do, and if effective the patient can use a home traction device for pain from a cervical herniated disc.
Chiropractic manipulation. Gentle manipulation can help reduce the joint dysfunction that may be an added component of the pain. High velocity manipulations should be avoided as
they can make the pain worse, or worsen any neurological damage.
Osteopathic medicine. Osteopathic manipulation and special techniques to restore normal
joint motion can be helpful in reducing pain from a cervical herniated disc.
Activity modification. Some types of activities may tend to exacerbate the herniated disc
pain and it is reasonable to avoid these activities to keep from irritating the nerve root. Such
activities may include heavy lifting (over 50 pounds), activities that can cause increased vibration and compression to the cervical spine (boating, snowmobile riding, running, etc.), and overhead activities that require prolonged neck extension and/or rotation.
Bracing. In some instances a cervical collar or brace may be recommended to help provide some rest for the cervical spine.
Medications. In addition to the anti-inflammatory medications mentioned above, narcotic
agents (pain killers) might be used on a temporary basis to help reduce the pain and discomfort from a cervical herniated disc. Also, muscle relaxants or certain anti-depressants may help reduce the nerve-type pain (neuropathic pain) and help restore normal sleep patterns.