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

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

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.

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.

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.