Facet-Mediated Pain

What is facet-mediated pain?

Facet-mediated pain or posterior element pain is caused by irritation or inflammation of the facet joints (zygapophyseal joints). The facet joints are diarthrodial joints with a synovial lining, the surfaces of which are covered with hyaline cartilage, susceptible to arthritic changes and arthropathies. Repetitive stress and osteoarthritic changes to the facet joint can lead to facet overgrowth. Like any synovial joint, degeneration, inflammation, and injury can lead to pain with joint motion, causing restriction of motion secondary to pain, and thus deconditioning. There are four facet joints associated with each vertebra. These facet joints interlock with other facets above and below the vertebra, thus forming a joint. Symptoms of facet-mediated pain are often difficult to isolate. Typically, the pain will occur in the low back and have a deep aching quality. The pain may radiate to the buttock and posterior thigh but rarely radiates below the knee. Pain is often exacerbated with lumbar extension, twisting or side-bending.

What are some signs and symptoms of facet-mediated pain?

Facet joint pathology should be suspected if the patient describes nonspecific low back pain with a deep and achy quality, usually localized to one or both sides of the spine. This pain may radiate to the buttock and posterior thigh, but usually not below the knee. The pain is often exacerbated by extension, twisting of the back, stretching and when there is a torsional load. Some patients describe their pain as worse in the morning, aggravated by rest and hyperextension and relieved by repeated motion.

How is facet-mediated pain diagnosed?

Establishing a diagnosis of facet-mediated pain is difficult due to nonspecific findings and poor correlation between the history and physical examination. Obtaining a detailed history and physical examination helps rule out other entities and also assists with guiding the examiner in establishing the diagnosis of facet-mediated pain.
The basic history should include a temporal account of the symptoms and a complete description of the complaint, as well as the associated activities that cause or alleviate the pain. The patient should describe the location of pain, whether it is isolated or radiating, and its intensity, character and frequency. The clinician should also obtain a prior treatment history (eg, injections, medications, therapy) and their success.

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