AB1102 Effectiveness of facet joint injection in low back pain
Authors: L.H. Ribeiro, R.N.V. Furtado, M. Konai, A. Rosenlfeld, A.B. Andreo, J. Natour
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Lumbar facet joints are a well recognized source of low back pain. Studies have shown the prevalence of lumbar facet joint pain in 30% to 40% of the patients with chronic low back pain. Facet joint interventions, including intra-articular injections, medial branch nerve blocks are used to manage facet-mediated spinal pain. Several studies have evaluated the effectiveness of these interventions. Results of facet joint injection, however, are conflicting. <h3>Objectives</h3> Primary: to evaluate the effectiveness of facet joint injection with corticosteroids on pain secondary: to evaluate the effectiveness of facet joint injection with corticosteroids on functional capacity and quality of life <h3>Methods</h3> Sixty subjects with diagnostic of facet joint syndrome were enrolled in the study. They were randomized into experimental (EG) and control group (CG). The EG was submitted to intra-articular injection of six facet joints (L3/L4;L4/L5;L5/S1 bilaterally) with triamcinolone hexacetonide. The CG was submitted to triamcinolone acetonide intramuscular injection on six lumbar paravertebral points. After randomization, all subjects were assessed by an investigator blinded to the groups. The assessment were taken before interventions and them 1, 4, 12 and 24 weeks after the interventions. Outcome measures were used: pain visual analogical scale, pain visual analogical scale on extension of the spine, Likert scale, percentage scale of improving, Rolland-Morris questionnaire, short health survey questionnaire (SF36), accountability of analgesics and non-steroidal antiinflamatories taken for pain. Statistical analysis: sample homogeneity was tested using Student’s T, Pearson’s Chi- Square and Mann-Whitney tests. ANOVA was performed to evaluate inter and intra-group differences. <h3>Results</h3> There were no significant differences in the baseline characteristics between the two groups. The experimental group showed a significant improvement in the physical aspects domain, assessed by SF-36. At visit 1 the experimental group showed a better response of improving (much better) assessed by the Likert scale. However in the following visits both groups had similar results. The consumption of NSAIDs were significantly lower in the experimental group at the last visit (T12 e 24). <h3>Conclusions</h3> Facet joint injection had a weak effectiveness. The improvement was observed in few aspects of quality of life and self-assessment of improving. However it provided a reduction in NSAIDs intake <h3>References</h3> Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi Set al: American Society of Interventional Pain Physicians. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Physician.2007; 10: 7-111 Helbig T, Lee CK. The lumbar facet syndrome. Spine 1988; 13: 61-4 Manchikanti L, Singh V, Kloth D et al. Interventional techniques in the management of chronic pain: Part 2.0. Pain Physician 2001; 4:24-96. Niemisto L, Kalso E, Malmivaara A. Radiofrequency denervation for neck and back pain: a systematic review within the framework of the Cochrane collaboration back review group. Spine 2003; 28:1877- 88. Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine 2009; 34: 49-59 <h3>Disclosure of Interest</h3> None Declared