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Are you suffering from chronic low back pain? Is the pain across your low back, radiating to your butt and the back of your thighs? Does it hurt to lean backwards? Twist? Does it feel worse with inclement weather (cold, rain)? Do you suffer from arthritis elsewhere in your body?

If the answers are to the above a resounding “yes,” then you might be suffering from something call facetogenic low back pain. In summary, the facets are the joints that connect the back of the spine. Like any other joints in our bodies, as we age, these too may become degenerative, arthritic, and pain yielding.

So how do we tackle this type of pain? Conservatively, we often start with medications such as NSAIDs (e.g. ibuprofen), lidocaine patches and physical therapy. For pain that persists, we consider interventional pain techniques.

  1. One common technique is to inject the facet joint itself with a little bit of steroid to decrease the inflammatory joint.
  2. Another common technique is to numb the tiny little nerves, “Medial Branch Nerves,” that innervate these facet joints. This procedure is called a “Lumbar Medial Branch Block.”

The lumbar medial branch block procedure involves lying face down on the procedure table for 4-8 acupuncture style injections. The procedure is considered quick, low risk, diagnostic and therapeutic.

  • It’s diagnostic in the sense that we inject local anesthetic at each Medial Branch Nerve. The local anesthetic is similar to having your teeth numbed at the dentist’s office, where the numbness wears off after a few hours. In the same way, the local anesthetic may make your low back pain feel almost immediately improved. You may appreciate improved flexibility, particularly leaning backwards and twisting. However, similar to the dental’s office, the local anesthetic effect may wear off by the evening or next day. Nonetheless, any pain relief appreciated is important to note and tell your doctor, as it helps us diagnose your low back pain as being attributed to your facet joints.
  • The procedure is also considered therapeutic because we inject steroid at each Medial Branch Nerve. The steroid typically kicks in within 5-10 days and provides relief for several weeks to months.

For some patients, the lumbar medial branch block procedure provides positive diagnostic results, however the relief from the steroid treatment is either short-lived or unsatisfying. For these patients we consider a follow-up procedure called a medial branch “radiofrequency ablation” (RFA). This radiofrequency ablation procedure targets the same lumbar medial branch nerves as the lumbar medial branch block, however instead of just injecting local anesthetic with steroid, this time we advance a more specialized needle towards the medial branch nerves. Once this specialized needle is in the correct position, we heat up the needle tip to burn away the tiny medial branch nerves. This RFA procedure is still considered fairly low risk, takes about 20 minutes to do, and commonly provides patients superior pain relief for 6-12 months.

Are you interested in lumbar medial branch blocks or radiofrequency ablations? Still have questions? Please reach out to us!

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