Is Your Low Back Pain From Arthritis? Written by Christopher S. Vihlen, M.D.

by TOI Admin May 21, 2018
Back pain is very common with multiple possible sources for the pain.  If the pain starts in the back and travels into the thigh and/or below the knee, the problem is probably sciatica, a pinched nerve in the back. However, if the pain is primarily in the back, possibly with some pain in the buttocks and thighs, then the problem could very well be arthritis.

FACET JOINTS

The arthritis that could be causing the back pain is in the small joints in your back called facet joints. Your spine, from your neck to your low back, is made up of 24 vertebrae. Each vertebrae can bend or flex with the ones above and below at the facet joints. And, like any joint in the body, the facet joints can develop arthritis. This is usually from overuse.
Treatment for facet joint pain includes physical therapy, oral medications, injections, and surgery. Often, in that order. 

INJECTIONS

Injections are usually done after more conservative treatment, such as physical therapy and oral medications, have not offered substantial relief. These injections have traditionally included steroid injections into the painful joint or joints. However, research has supported a procedure directed at the nerves which block the pain signal traveling from the joint to your brain. This is called radiofrequency neurotomy 
(ablation/rhizotomy).

RADIOFREQUENCY NEUROTOMY

Radiofrequency neurotomy is a procedure that uses heat to destroy tiny nerves that transmit the painful signal in your facet joints up to your brain. So, although the arthritis persists, you don’t suffer its affects all day, every day. The procedure starts with sterilizing and numbing the skin. Then small needles are inserted towards the responsible nerves using x-ray guidance. Once the needles are in position, a special machine generates very focal precise heat to burn a short segment of the nerve. The painful signal can no longer travel back to the brain.

ARE YOU A CANDIDATE?

To confirm you are a good candidate for the radiofrequency neurotomy, two preliminary diagnostic injections are performed using local numbing medicine. If numbing the offending nerves, which go to the painful arthritic joints, relieves your pain, then you are a good candidate. These preliminary injections are called medial branch blocks. They get this name because the small nerves which ultimately get burned are called the “medial branches,” and we are “blocking” them with numbing medicine. This preliminary injection only lasts hours, but 
it is a good test to prove you will ultimately benefit from the radiofrequency neurotomy. 
If you have back pain and would like to know more about various treatments, please contact The Orthopaedic Institute.
Christopher S. Vihlen, M.D. is a board certified diagnostic radiologist. He completed his undergraduate education at Vanderbilt University and went on to attend the University of Florida College of Medicine. His residency and fellowship training were also completed at the University of Florida. Dr. Vihlen practices out of TOI’s Gainesville location.
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