Pain from facet joints is very common, particularly as the general wear-and-tear on these joints over time causes degeneration and arthritis. Most people with facet joint pain have axial pain (along the spine), usually in the lower lumbar region. It can also present along the neck. Your pain may be worse with spine extension, twisting, or prolonged standing. However, there are other sources of low back pain that can confound this diagnosis, including sacroiliac pain, muscle pain, and degenerative disc disease.
One good tool we have to try to clarify the diagnosis of facet joint pain is by using diagnostic facet joint blocks. During these procedures, the patient lies face down on a table with an X-ray C-arm overhead taking quick snapshots of the spine. Thin needles are inserted down to the bone, targeting the tiny nerves, or “medial branches” that innervate the joints. Then 1-2 cc’s of anesthetic medication is injected to “numb” the nerves. The procedure is relatively very safe and simple when performed by an experienced practitioner under X-ray guidance. Afterwards, within 15 minutes, the region of pain should feel numb. If the individual has great relief in his or her pain from these temporary nerve blocks, he/she may be a good candidate for more targeted therapy. See “Radiofrequency Ablation”.