Facet joint pain originates from the small, paired joints on the back of the spine that guide movement and prevent excessive rotation. This condition, often called facet joint syndrome, involves an arthritis-like breakdown of the cartilage, typically caused by wear and tear or injury. Symptoms manifest as a dull, aching pain in the lower back or neck that can radiate into the buttocks, hips, or shoulders. Pain is frequently worsened by extending the spine backward or twisting, but relief may be found by bending forward. Treating this complex spinal pain requires a coordinated approach involving several types of doctors and specialists.
The First Step Initial Consultation and Diagnosis
Most individuals begin by consulting a primary care physician (PCP) or internist, who serves as the initial point of contact for generalized back pain. The PCP takes a comprehensive medical history, performs a physical examination, and rules out more serious causes of spinal pain. They often initiate conservative treatment with NSAIDs or muscle relaxants and may order initial imaging, such as X-rays, to assess for structural changes.
A physiatrist, specializing in Physical Medicine and Rehabilitation (PM&R), may also be the first specialist consulted, especially for complex musculoskeletal issues. Physiatrists are experts in diagnosing and treating conditions of the nerves, muscles, and bones without surgery. They use imaging and electrodiagnostic tests to pinpoint the precise source of pain and develop a nonsurgical treatment plan.
Specialists in Non-Surgical Pain Management
The majority of facet joint pain is managed through non-surgical interventions directed by pain management specialists. These specialists are often anesthesiologists or physiatrists with fellowship training focused on interventional pain procedures. They are skilled in performing highly specific, image-guided injections used for both diagnosis and treatment.
A crucial diagnostic tool is the medial branch block, where an anesthetic is injected near the small medial branch nerves that transmit pain signals from the facet joint. If the patient experiences significant, temporary pain relief, this confirms the facet joint as the source of discomfort. For therapeutic relief, a corticosteroid and numbing agent injection may be placed directly into the facet joint capsule to reduce inflammation and swelling.
If temporary relief from injections is achieved, the next step is often radiofrequency ablation (RFA), also known as rhizotomy. This procedure uses radiofrequency energy to heat and temporarily destroy the medial branch nerve fibers. RFA blocks the pain signal transmission for an extended period, often lasting from nine months to over two years.
When Surgical Treatment is Necessary
Surgical intervention for facet joint pain is reserved for patients whose pain is severe despite comprehensive non-surgical management, or when there is significant spinal instability or neurological compression. The primary surgical specialists involved are Orthopedic Spine Surgeons and Neurosurgeons. These surgeons are trained to address complex spinal pathology, including conditions affecting the facet joints.
Procedures may include a spinal fusion, where two or more vertebrae are permanently joined together to eliminate motion in the painful segment and provide stability. Other surgeries, such as a facetectomy or laminectomy, may be performed to trim away excess bone or remove parts of the vertebra. These operations decompress spinal nerves that have become impinged due to facet joint enlargement.
Rehabilitation and Functional Recovery Providers
The treatment plan relies heavily on allied health professionals who focus on restoring function and preventing recurrence. Physical Therapists (PTs) develop individualized exercise programs to strengthen the core musculature, which stabilizes the spine and reduces mechanical stress on the facet joints. They teach patients targeted stretching and functional movement techniques to improve posture and body mechanics.
Chiropractors may also play a role in managing facet joint pain by focusing on spinal alignment and mobility. They utilize manual adjustments and mobilization techniques to help restore proper movement and reduce stiffness in the affected spinal segments. These providers address underlying biomechanical issues, helping patients maintain the benefits achieved through medical treatments.