Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Facet Joint Injections for Low Back Pain Improve Quality of Life.

Mercieca2,  Cecilia, Zammit2,  Stefania Chetcuti, Lauri1,  Josef, Borg2,  Andrew Albert

Department of Mathematics, University of Malta, Malta
Department of Rheumatology, Mater Dei Hospital, Msida, Malta

Aim:

To ascertain whether facet joint injections improve Quality of Life in chronic low back pain. Secondary endpoints studied included procedure efficacy and safety.

Patients and Methods:

40 patients suffering from low back pain due to facet joint disease [1] were recruited. All patients had degenerative changes in their facet joints on radiographs. Severity of back pain was assessed at baseline and after one month. Patients were asked about any improvement in back pain, activities of daily living (ADLs) and walking ability they expected as a result of the procedure. These responses were measured using 10mm VAS and correlated with the actual outcomes one month after injection. The Roland-Morris disability (RDQ) [2] and the Oswestry [3] questionnaires were also administered at baseline and one month after the intervention.

Results:

40 patients underwent facet joint injection (11 males, 29 females). There was significant improvement in pain and disability according to the RDQ. The mean score at baseline was 13.1 (CI 12.33–17.76) while after one month it was 10.4 (CI 9.63–15), p=0.008. No significant improvement was found using the Oswestry questionnaire (p=0.9). There was a strong correlation between high expectations of improvement at baseline and actual improvement at one month in ADLs (r=0.7; p=0.001), improvement in back pain (r=0.37; p=0.026), but not for walking ability (r=0.25; p=0.132). Gender, BMI, age and severity of back pain did not influence outcomes.

The lack of correlation between severity of back pain at baseline and the actual improvement in back pain at one month suggests that the degree of improvement depended more on the individual's expectation of benefit rather than the actual back pain severity.

More than 70% felt the procedure helped and 60% of them were willing to undergo the procedure again. Prior to the procedure over 60% expected complications although none occurred, confirming that the procedure is safe.

Conclusions:

Evaluating treatment outcome for low back pain has always generated considerable interest. This study shows that facet joint injections reduce disability as measured by the RDQ with a clinically significant change of nearly three points in the scale. This study further suggests that the two disability measures studied should not be used uncritically as their complexity varies and the domains that they cover are different.

Additionally, the patient's expectation of improvement from the facet joint injection was a better predictor of improved outcome than the initial severity of back pain reinforcing the concept of a multifactorial aetiology for the pain. Patients with very low expectations of benefit from this procedure tended to have poorer outcomes and little improvement in quality of life. This is relevant when selecting patients for facet joint injection. Facet joint injections are a safe and useful adjunct in the treatment of low back pain.

References.

1.Jackson, RP, Jacobs, RR & Montesano, PX. Spine. 1988;13(9):966–71.

2.Roland, MO & Morris, RW. Spine 1983;8: 141-144.

3.Fairbank, JCT & Pynsent, PB. Spine 2000;25:2940-2953.

To cite this abstract, please use the following information:
Mercieca, Cecilia, Zammit, Stefania Chetcuti, Lauri, Josef, Borg, Andrew Albert; Facet Joint Injections for Low Back Pain Improve Quality of Life. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :172
DOI: 10.1002/art.27941

Abstract Supplement

Meeting Menu

2010 ACR/ARHP