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Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial

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Abstract

Purpose

This prospective randomized trial is to determine the effectiveness of treating lumbar facet syndrome with oral diclofenac, methylprednisolone facet joint injection or both.

Methods

We enrolled lumbar facet syndrome patients treated at Srinagarind Hospital. Enrolled patients were randomly assigned to receive 100 mg/day oral diclofenac, an 80 mg injection of methylprednisolone into each symptomatic facet joint, or both. Endpoints were the Oswestry disability index (ODI) and visual analogue scale (VAS) before treatment, and at four and 12 weeks after treatment.

Results

Of the 99 patients, the mean age was 46.4 years and 48 were men. The initial ODI (mean ± SD) for the diclofenac, methylprednisolone and combined treatment was 45.1 ± 9.3, 42.9 ± 15.6, and 42.2 ± 11.5, respectively. The respective four week ODI was 30.1 ± 8.1, 20.2 ± 8.0, and 15.1 ± 5.5. The 12-week ODI was 42.4 ± 9.0, 32.2 ± 15.6, and 26.2 ± 11.7. The initial VAS was 7.1 ± 1.2, 7.6 ± 1.1, and 7.3 ± 1.0. The four week VAS was 5.3 ± 1.4, 3.6 ± 0.7, and 3.3 ± 1.1. The 12-week VAS was 6.1 ± 1.1, 5.8 ± 1.4, and 5.1 ± 0.9. The four week ODI and VAS for the combined treatment and the methylprednisolone treatment were significantly less than the diclofenac alone. The combined treatment also showed better scores than the methylprednisolone injection. Within each treatment, the best treatment effect was found at four weeks after which the ODI and VAS gradually increased but were still less than the initial scores.

Conclusions

The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.

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References

  1. Beresford ZM, Kendall RW, Willick SE (2010) Lumbar facet syndromes. Curr Sports Med Rep 9:50–56

    Article  PubMed  Google Scholar 

  2. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8:396–401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Fritz J, Niemeyer T, Clasen S, Wiskirchen J, Tepe G, Kastler B et al (2007) Mangement of chronic low back pain: rationales, principles, and targets of imaging-guided spinal injections. Radiographics 27:1751–1771

    Article  PubMed  Google Scholar 

  4. Cohen SP, Raja SN (2007) Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Aneshtesiology 106:591–614

    Article  Google Scholar 

  5. Mens JM (2005) The use of medication in low back pain. Best Pract Res Clin Rheumatol 19:609–621

    Article  PubMed  Google Scholar 

  6. Culling RD, Rice JH (1992) Corticosteroid injections for chronic low back pain. N Engl J Med 326:834

    Article  CAS  PubMed  Google Scholar 

  7. Helbig T, Lee CK (1988) The lumbar facet syndrome. Spine 13:61–64

    Article  CAS  PubMed  Google Scholar 

  8. Jackson RP, Jacobs RR, Montesano PX (1988) Facet joint injection in low-back pain: a prospective statistical study. Spine 13:966–971

    Article  CAS  PubMed  Google Scholar 

  9. Ribeiro LH, Furtado RNV, Konai MS, Andreo AB, Rosenfeld A, Natour J (2013) Effect of facet joint injection versus systemic steroids in low back pain. Spine 23:1995–2002

    Article  Google Scholar 

  10. Eisenstein SM, Parry CR (1987) The lumbar facet arthrosis syndrome:clinical presentation and articular surface changes. J Bone Joint Surg Br 69:3–7

    CAS  PubMed  Google Scholar 

  11. Sae-Jung S, Hunzawong T, Jirarattanaphochai K (2002) Reliability of Thai version of Oswestry quesionnaire for the evaluation of low back pain patients. Srinagarind Med J 17:247–253

    Google Scholar 

  12. Kalichman L, Hunter DJ (2007) Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum 37:69–80

    Article  PubMed  Google Scholar 

  13. Cavanaugh JM, Ozaktay AC, Yamashita HT, King AI (1996) Lumbar facet pain: biomechanics, neuroanatomy and neurophysiology. J Biomech 29:1117–1129

    Article  CAS  PubMed  Google Scholar 

  14. Gellhorn AC, Katz JN, Suri P (2013) Osteoarthritis of the spine: the facet joints. Nat Rev Rheumatol 9:216–224

    Article  PubMed  Google Scholar 

  15. Pneumaticos SG, Chatziioannou SN, Hipp JA, Moore WH, Esses SI (2006) Low back pain: prediction of short-term outcome of facet joint injection with bone scintigraphy. Radiology 238:693–698

    Article  PubMed  Google Scholar 

  16. Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M et al (1998) Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia: proposed criteria to identify patients with painful facet joints. Spine 15:1972–1976

    Article  Google Scholar 

  17. Lippitt AB (1984) The facet joint and its role in spine pain: management with facet joint injection. Spine 9:746–750

    Article  CAS  PubMed  Google Scholar 

  18. Silbergleit R, Mehta BA, Sanders WP, Talati SJ (2001) Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics 21:927–939

    Article  CAS  PubMed  Google Scholar 

  19. Anand S, Butt MS (2007) Patients' response to facet joint injection. Acta Orthop Belg 73:230–233

    PubMed  Google Scholar 

  20. Hestbaek L, Kongsted A, Jensen TS, Leboeuf-Yde C (2009) The clinical aspects of the acute facet syndrome: results from a structured discussion among European chiropractors. Chiropr Osteopat. doi:10.1186/1746-1340-17-2

    PubMed  PubMed Central  Google Scholar 

  21. Simon J, McAuliffe M, Shamim F, Vuong N, Tahaei A (2014) Discogenic low back pain. Phys Med Rehabil Clin N Am 25:305–317

    Article  PubMed  Google Scholar 

  22. Freiermuth D, Kretzschmar M, Bilecen D, Schaeren S, Jacob AL, Aeschbach A, Ruppen W (2015) Correlation of (99m) Tc-DPD SPECT/CT scan findings and diagnostic blockades of lumbar medial branches in patients with unspecific low back pain in a randomized-controlled trial. Pain Med 16:1916–1922

    Article  PubMed  Google Scholar 

  23. Brummett CM, Cohen SP (2014) Pathogenesis, diagnosis, and treatment of zygapophyseal (facet) joint pain. In: Benzon H, Rathmell JP, Wu CL, Turk DC, Argoff CE, Hurley RW (eds) Practical management of pain. Mosby, Philadelphia, pp 816–845

    Chapter  Google Scholar 

  24. Chang HJ, Lynm C, Glass RM (2010) Osteoarthritis of the lumbar spine. JAMA 304:114

    Article  CAS  PubMed  Google Scholar 

  25. Chou R (2010) Low back pain (chronic). BMJ Clin Evid 2010:1116

    PubMed  PubMed Central  Google Scholar 

  26. Brand ES, Ky P, Christo PJ, Standaert CJ, Akuthota V (2009) Debating ”interventions“ for chronic axial low back pain. PM R 1:964–972

    Article  PubMed  Google Scholar 

  27. Ruiz FK, Bohl DD, Webb ML, Russo GS, Grauer JN (2014) Oswestry disability index is a better indicator of lumbar motion than the visual analogue scale. Spine J 14:1860–1865

    Article  PubMed  Google Scholar 

  28. Yavuz U, Sökücü S, Albayrak A, Oztürk K (2012) Efficacy comparisons of the intraarticular steroidal agents in the patients with knee osteoarthritis. Rheumatol Int 32:3391–3396

    Article  CAS  PubMed  Google Scholar 

  29. Manchikanti L, Kaye AD, Boswell MV, Bakshi S, Gharibo CG, Grami V et al (2015) A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Pain Physician 18:E535–E582

    PubMed  Google Scholar 

  30. Barr KP, Griggs M, Cadby T (2005) Lumbar stabilization: core concepts and current literature, Part 1. Am J Phys Med Rehabil 84:473–480

    Article  PubMed  Google Scholar 

  31. Mars T, Ellard DR, Antrobus JH, Cairns M, Underwood M, Haywood K et al (2015) Intraarticular facet injections for low back pain: design considerations, consensus methodology to develop the protocol for a randomized controlled trial. Pain Physician 18:473–493

    PubMed  Google Scholar 

  32. Chambers H (2013) Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 11:106–120

    Article  PubMed  Google Scholar 

  33. Poetscher AW, Gentil AF, Lenza M, Ferretti M (2014) Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 39:E842–E849

    Article  PubMed  Google Scholar 

  34. Maas ET, Ostelo RW, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW (2015) Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. doi:10.1002/14651858.CD008572.pub2

    Google Scholar 

  35. Saltychev M, Laimi K (2014) Re: Poetscher AW, Gentil AF, Lenza M, Ferretti M (2014) Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 39:E1498–E1500

    Article  PubMed  Google Scholar 

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Acknowledgements

The study was supported by the New Researcher Grant, Khon Kaen University, Khon Kaen, Thailand. The authors would like to acknowledge Mr. Bryan Roderick Hamman and Mrs. Janice Loewen Hamman, for editing the manuscript via Publication Clinic of Khon Kaen University, Thailand.

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Surachai Sae-Jung & Kitti Jirarattanaphochai

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  1. Surachai Sae-Jung
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  2. Kitti Jirarattanaphochai
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Correspondence to Surachai Sae-Jung.

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The authors have no competing interests.

The manuscript submitted does not contain information about medical device(s)/drug(s).

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This is original work from the Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Thailand, and it has not been presented elsewhere nor under consideration by another journal. The authors participated in the design, execution, analysis and writing up of the research.

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Sae-Jung, S., Jirarattanaphochai, K. Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial. International Orthopaedics (SICOT) 40, 1091–1098 (2016). https://doi.org/10.1007/s00264-016-3154-y

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  • DOI: https://doi.org/10.1007/s00264-016-3154-y

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