Arthritis refers to the group of diseases that cause pain and inflammation and limit mobility in joints. It is the leading cause of disability in the United States, resulting in costs of $128 billion annually (CDC, 2010). What’s more, it is associated with substantial activity limitation, and reduced quality of life (CDC, 2003).
According to the most recent data released by the Centers for Disease Control and Prevention (CDC), an estimated 50 million adults in the United States report being told by a doctor that they have some form of arthritis, rheumatoid arthritis, gout, lupus, or other (CDC, 2010). Although half of these individuals are over age 65, arthritis is not just a disease of the elderly. In fact, An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition, and 7.6% of persons ages 18–44, as well as 29.8% of people ages 45–64 report doctor-diagnosed arthritis (CDC, 2010).
The two main forms of arthritis are osteoarthritis (OA) and rheumatoid arthritis (RA). Normally, OA is characterized by degeneration of joint cartilage and bone and affects the hips, hands, spine and knees. Disease onset is gradual and usually begins after the age of 40. In RA, inflammation of the synovial membrane, or lining of the joints, causes pain, swelling, cartilage and bone erosions, and joint deformity. RA is believed to be an autoimmune ailment, or a disease theoretically caused by an excessive immune response where the body mistakenly attacks its own tissues. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest.
Currently, there is no cure for arthritis. However, the pain specialists at Louisiana Pain are experienced in the management of arthritis and offer a variety of effective lifestyle recommendations as well as proven treatments to help reduce pain and increase mobility.
Typically, non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen and naproxen, are prescribed to arthritis patients for their potent analgesic and anti-inflammatory effects. However, spinal arthritis patients looking to avoid or reduce use of NSAIDs may find a viable solution in Facet Injections and Medial Branch Blocks (MBBs).
Spinal Arthritis: Facet Injections/Medial Branch Blocks (MBBs)
The interacting surfaces of each spinal facet joint are protected by smooth cartilage and lubricated by a special fluid, which together combat friction in the joint. Since facet joints are in almost continual use, wear and tear on sliding surfaces may promote the development of painful conditions. In some cases, degenerative changes in facet joint bone represent the onset of facet joint arthritis. Facet injections, a minimally invasive procedure, decrease inflammation and irritation in the facet joints of the spine. Generally, these blocks are safe, quick and easily performed under fluoroscopic guidance.
The medication included in facet injections can include a local anesthetic and long-lasting steroid. By numbing affected nerves, the numbing medication temporarily halts transmission of pain signals to the brain, and the slow-release steroid combats inflammation. When the injection is delivered around the medial branch nerves that innervate the facet joint, it is called a Medial Branch Block, or MBB. Medial Branch Blocks have been reported as particularly effective in treating neck pain.
Patients who receive facet injections/MBBs report rapid relief of symptoms. Often, they are able to resume their normal level of activity immediately. Further, the efficacy of these injections is supported by several studies. For example, researchers who conducted a two-year review of literature concluded that controlled comparative local anesthetic blocks of facet joints are reproducible, reasonably accurate and safe (Sehgal, 2007). And a Swiss study on patients with chronic lower back pain who were receiving facet injections concluded the treatment appeared to have a beneficial medium-term effect in one-third of patients with chronic lower back pain and may therefore be a reasonable adjunct to nonoperative treatment (Gorbach, 2006). And a Korean retrospective review of medical records of 60 consecutive patients found use of MBBs for lumbar facet syndrome provided relatively prolonged period of pain relief without major side effects (Son J et al, 2010). Specifically, each procedure seemed to provide successful pain relief for about 10 months in more than 85% of carefully selected patients.
Joint Replacement
When more conservative treatments consistently fail to bring relief to arthritis patients, a physician may recommend a full joint replacement. By swapping the worn-out joint with a plastic and/or metal prosthesis, the discomfort of arthritis may be completely reversed, allowing the patient to resume normal activities precluded by arthritis pain. While knee and hip replacements are the most common, replacement of shoulders, elbows and finger joints are becoming more prevalent as technology advances. Although joint replacements are extremely effective in alleviating arthritis pain, post-surgery recovery time is often long and may result in complications that are not associated with less invasive options.
Louisiana Pain Specialists cares about your quality of life and understands the burden of living with pain. Our caring practitioners understand the stress and inconvenience of living with a painful condition and aim to bring you back to health as quickly, efficiently and non-invasively as possible. With our numerous combined years of experience, we are confident we can design the best pain management plan for you.
Sources
CDC. (2010). “Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation” — United States, 2007—2009. Morbidity and Mortality Weekly Report (MMWR). 59(39);1261-1265
CDC. (2006). “Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation” — United States, 2003—2005. Morbidity and Mortality Weekly Report (MMWR). 55(40);1089-1092.
Gorbach, C. (2006). Therapeutic efficacy of facet joint blocks. AJR Am J Roentgenol, 186(5), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16632710
Hildebrandt, J. (2001). [relevance of nerve blocks in treating and diagnosing low back pain--is the quality decisive?]. Schmerz, 15(6), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11793154
Sehgal, N, et al. (2007). Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Physician, 10(1), Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17256031
Son J, et al. (2010). The efficacy of repeated radiofrequency medial branch neurotomy for lumbar facet syndrome.J Korean Neurosurg Soc. 48(3):240-3.
