Pain Conditions
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      2. Pain Conditions

      Facet Joint Syndrome

      Brief Overview: Facet joint syndrome refers to chronic pain caused by degeneration or arthritis of the facet joints, which are the small stabilizing joints located between the vertebrae of the spine. It is often a source of chronic low back or neck pain, especially in older adults, and may be confused with disc-related pain.

      Etiology:

      • Degenerative arthritis/osteoarthritis of facet joints
      • Spinal degeneration from aging
      • Repetitive stress or trauma to the spine
      • Poor posture or prolonged sitting
      • Secondary to disc degeneration (increased stress on facet joints)

      Risk Factors:

      • Advanced age
      • Obesity (increased load on spine)
      • Occupations requiring repetitive lifting, twisting, or prolonged sitting/standing
      • History of spine trauma or surgery
      • Osteoarthritis or other degenerative joint disease
      • Sedentary lifestyle with weak core and back muscles

      Commonly Associated Conditions:

      • Osteoarthritis and degenerative disc disease
      • Spinal stenosis
      • Chronic low back or neck pain
      • Radiculopathy (if nerves are secondarily compressed)
      • Depression or anxiety from chronic pain

      Common Medications:

      • Tylenol, topical NSAIDs
      • Oral NSAIDs: ibuprofen, naproxen (short-term; caution in some)
      • Muscle relaxants: short-term for spasms (avoid long-term in seniors)
      • Neuropathic agents: duloxetine, gabapentin, pregabalin (if nerve irritation involved)
      • Opioids: last resort, for refractory cases under specialist care
      • Topical agents: lidocaine, capsaicin, or diclofenac gel
      • Corticosteroid injections: facet joint or medial branch blocks for targeted relief

       

      Common Labs, Imaging, and Tests:

      • X-ray, MRI
      • Diagnostic facet joint injection

      Common Symptoms:

      • Pain
      • Stiffness
      • Poor posture
      • Referred pain
      • Radiating pain

      Common Treatments:

      • Non-Pharmacologic:
        • Physical therapy: stretching, strengthening, posture correction
        • Heat or ice for flare-ups
        • Weight management to reduce spine load
        • Ergonomic adjustments (chairs, workstations, mattress)
        • Low-impact exercise (walking, swimming, yoga, tai chi)
      • Pharmacologic:
        • Stepwise use of acetaminophen, NSAIDs, neuropathic agents, topical therapies
        • Corticosteroid injections into facet joints or medial branch blocks for persistent pain
      • Interventional:
        • Radiofrequency ablation
        • Rarely, surgery if severe degeneration and instability

      Physical Findings:

      • Local tenderness over facet joints
      • Pain with spinal extension, rotation, or lateral bending
      • Limited range of motion in spine
      • Muscle tightness or spasm in paraspinal muscles
      • Neurological exam typically normal (unless other pathology present)

      Potential Complications and Contraindications:

      • Complications:
        • Chronic pain and reduced mobility
        • Sleep disturbance, mood disorders
        • Disability and reduced independence
        • Medication overuse (NSAIDs, opioids)
      • Contraindications:
        • NSAIDs: avoid in patients with kidney, GI, or cardiovascular disease
        • Muscle relaxants: avoid long-term (risk of sedation, falls)
        • Opioids: avoid chronic use unless managed by pain specialist
        • Repeated steroid injections may weaken bone and cartilage

      General Health and Lifestyle Guidance:

      • Encourage daily gentle movement to prevent stiffness
      • Strengthen core and back muscles to stabilize spine
      • Maintain a healthy weight
      • Practice good posture and ergonomics when sitting, standing, and lifting
      • Use heat/ice therapy during flare-ups
      • Sleep on a supportive mattress and avoid prolonged bed rest
      • Stress management (deep breathing, mindfulness) to reduce muscle tension

      Suggested Questions to Ask Patients:

      • Where is your pain located, and does it spread anywhere?
      • What activities make your pain worse or better?
      • Do you notice stiffness in the morning or after long periods of sitting?
      • Do you take pain medications? How often? Do they help?
      • Have you tried physical therapy or exercises for your back/neck?
      • Do you use supportive devices (braces, ergonomic chairs, walking aids)?
      • How does the pain affect your sleep, mobility, or daily activities?

      Suggested Talking Points:

      • Facet joint pain is a common cause of back or neck pain as we age.
      • The pain often feels worse when leaning back or twisting but can improve with gentle movement.
      • Staying active, using proper posture, and strengthening your core are key to managing symptoms.
      • We want to avoid overusing medications like NSAIDs or opioids.
      • Injections or procedures may help if pain is severe, but many people benefit from lifestyle changes and therapy.

       

       

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.