Facet joint osteoarthritis as a cause of chronic low back pain

Abstract

Chronic nonspecific low back pain (LBP) is the most common cause of disability and a lower quality of life in modern society.Objective: to discuss the feasibility of identifying the causes of chronic nonspecific LBP and in the case of detection of damage to the facet joint (FJ) or sacroiliac joint (SIJ), use of nonsteroidal anti-inflammatory drugs (NSAIDs), and injection of anesthetics and glucocorticoids into the region of the FJ or SIJ.Patients and methods. A total of 121 female patients aged 22 to 59 years with chronic nonspecific LBP were followed up. A FJ lesion was found in 53 (43.8%) patients. The patients were informed of a favorable disease prognosis, had motor activity recommendations, and were also prescribed NSAIDs and muscle relaxants. Twenty-eight (23%) patients achieved a clinically significant analgesic effect within 2 weeks; the remaining 93 (77%) patients received combination therapy with anesthetics injected into the region of the FJ and SIJ.Results and discussion. The basis for successful personified therapy in these patients is shown to be adequate diagnosis by identifying of the prevailing sources of pain impulses (triggers), and by using minimally invasive diagnostic methods, such as local injection of a local anesthetic solution into the suspected pain trigger. The high efficiency of combination therapy for chronic nonspecific LBP, which included anesthetics injected into the region of the FJ and SIJ, and is largely associated with rapid pain elimination, which is of great psychological importance. The central mechanisms of action of NSAIDs, etoricoxib in particular, are discussed.Conclusion. Thus, elucidation of the causes of chronic nonspecific LBP in a patient makes it possible to recommend personalized therapy aimed at eliminating not only the symptoms, but also the underlying cause of the disease. The use of etoricoxib for FJ lesion, which shows the highest analgesic efficacy in patients with osteoarthritis is pathogenetically justified and should be combined with nondrug treatments.

Keywords

• osteoarthritis
• backache
• facet syndrome
• nociplastic pain
• musculoskeletal pain
• myofascial pain syndrome
• myoplasticity
• pain catastrophizing
• interventional therapy
• cognitive behavioral therapy
• rehabilitation
• etoricoxib
• arcoxia