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Integrated Pain Management


Facet syndrome

Facet syndrome refers to a condition where the zygapophysial joint (the synovial diarthroses from S1 to C2) cause back pains. About 31% of facet syndrome cases occur in the lumbar while 51% occur in the cervical vertebrae. Facet syndrome symptoms can progress to Spondylosis which is a spinal osteoarthritis.

facet joints

The facet joints are as a result of inferior and superior processes of each vertebra. There is an inferior articulating surface in the first cervical vertebrae but this does not limit the posterior or lateral translation and thus is not included as a roper zygoma, which means yoke in Greek.

Down in the lumbar spine, the facet joints account for 20% of low back twisting stability. Each of the facet joints is positioned at different levels of the spine to assist in support especially during a movement that involves rotation.

Facet joints also have a responsibility of preventing vertebrae from slipping over the one below it. There is a small capsule surrounding each of the facet joints and provides a lubricant that is nourishing to that particular joint.

All the joints have tiny nerve fibers which send pain messages when the joint is irritated or injured. An inflamed facet joint can be a great cause of muscle spasm.

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A patient suffering from facet joint syndrome may experience the following symptoms:

  • > Acute episodes of pain in cervical and lumbar facet joints are experienced, and will occur a number of times in a month or in a year, and are quite unpredictable. 

  • > There is a persisting tenderness over the inflamed joints and to some degree, the loss of spinal muscles flexibility.

  • > Low back pain emanating from the facet joint and radiates down to the buttocks and the back of the upper part of the leg. There are rare conditions where the pain is in the front of the leg or below the knee to the foot as it is the case with disc herniation. 

  • > There will be some difficulty when the patient leans backward and little or no discomfort when leaning forward.

Patients suffering from facet joint syndrome can experience recurrent pain which may be frequent and unpredictable in extent and timing. Patients are in most cases left with an idea that the pain is a psychosomatic issue and most perceive it as being ‘all in their head’.

If the condition is affecting the lumbar, standing is limited in some way but riding in a car or just sitting is the worst. At the climax of disability and pain, the involved muscle spasm is in a continual form that fatigues the involved muscles and this simply repeats the entire cycle causing more agony.


There are many causes behind the facet joint syndrome. Some of the common causes include whiplash injury to the neck and other forms of trauma. An abnormal or uncomfortable posture can result in the overloading of the spinal tissues and this can lead to the pain and inflammation of the facet joints.

The degenerative changes occurring in the lumbar, thoracic and cervical spine can result in abnormal strain and stress. The strain and stress can lead to an increase in the load on the joints and this is a common cause of facet joint syndrome.


When the unpredictable pain episodes are recurring on a monthly basis or in some cases more often, x-ray will show the abnormal facet joint changes. CT scans are however better because they have the ability to obtain more information about the facet joints as well as other significant spine structures.

MRI scans are not all that useful in the diagnosis of this condition but will come in handy in investigations involving abdominal or disc pain contributors.

The diagnosis believed to be the most effective is one involving an injection to the facet joint. This injection n is a mixture of a local anesthesia, x-ray contract material and cortisone. The relief of problem during this procedure is diagnostic.


There are a number of successful treatment methods which involve the breaking up of the recurring facet joint pain.

Non-invasive Treatment

There are various non-surgical treatment methods which might be employed in the treatment and management of facet joint syndrome. The most successful treatment option with long-lasting results is one involving proper physical exercise and instructions offered by a qualified physical therapist.

Good posture such as pulling the car seat forward for a normal spine curvature will contribute in the prevention of pain episodes. Heat wraps, hot showers, and hot water bottles, or cold pad applications have been reported to assist in the alleviation of the pain episodes.

Changing the daily activities such as taking shorter commutes and adding rest breaks in daily activities can assist in managing the pain. Patients can use anti-inflammatory medication such as NSAIDs to eliminate the pain.

Chiropractic manipulation can be used in the relief of pain but this will need to be done under the instructions of a medical practitioner. If the pain is on the neck then restraining collars and cervical traction are used in bringing temporal relief.

A supportive pillow is essential and the patient should avoid any nighttime flexion considered abnormal as well as the use of pillow piles and this might compromise the situation and trigger the pain episodes.

A more lasting solution to the facet joint syndrome problem might be the destruction of the nerve endings in the joints; this can be achieved using an electrified hot probe or a tip freezing probe technique which are performed under x-ray control. The muscle spasm can be treated using Botox injection.


Since facet joint syndrome can greatly affect a patient’s life, sometimes surgery becomes an option when the pain is not eliminated using not invasive methods.

The fortunate thing is that most of the patients suffering from facet joint syndrome can manage the condition with a simple combination of proper exercise, good posture and a change in lifestyle.