The inability of the clinical picture to characterize pain from facet joints

Abstract

Facet joints, as a source of low back pain, have attracted considerable attention and been a source of controversy in recent years. Significant progress has been made in precision diagnosis of chronic low back pain with neural blockade. In the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies, and in the face of mounting evidence showing lack of correlation between clinical features, physical findings, and diagnosis of facet joint mediated pain, controversial features have been described to validate the assumption of facet joint mediated pain by set criteria. The prevalence of lumbar facet joint mediated pain in patients with chronic low back pain has been established in this study as 42% using controlled comparative local anesthetic diagnostic blocks, with a false positive rate of 37%. The evaluation of role of various clinical features described in the literature, six features showed negative correlation with facet joint mediated pain. However, these six feature involved only a small number of patients. In conclusion, facet joint mediated pain is a common entity in patients suffering with chronic low back pain nonresponsive to conservative care, who present to a nonuniversity pain management practice. However, the history, clinical features, and radiological features are of no significance or assistance in making the diagnosis of facet joint mediated pain with certainty.