3. Pain originating from the lumbar facet joints.

Autor: Van den Heuvel SAS; Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands., Cohen SPC; Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA., de Andrès Ares J; Pain Unit Hospital Universitario La Paz-(Anesthesiology), Madrid, Spain., Van Boxem K; Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands., Kallewaard JW; Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands.; Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands., Van Zundert J; Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium.; Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Pain practice : the official journal of World Institute of Pain [Pain Pract] 2024 Jan; Vol. 24 (1), pp. 160-176. Date of Electronic Publication: 2023 Aug 28.
DOI: 10.1111/papr.13287
Abstrakt: Introduction: Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age.
Methods: The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.
Results: There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation.
Conclusions: Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
(© 2023 The Authors. Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.)
Databáze: MEDLINE
Externí odkaz: