Facet Joint Pain Podcast
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- čas přidán 30. 06. 2024
- Podcast hosted by Grant Cooper, M.D. with special guest Zinovy Meyler, D.O. on facet joint pain.
0:00 Introduction
4:22 What are Facet Joints?
10:00 Diagnosing Facet Joint Pain
11:45 What To Do About Facet Joint Pain?
32:12 Clinical Diagnosis - Facet Joint Block & Medial Branch Block
38:40 Radiofrequency Ablation (RFA)
1:12:12 Post Procedure Problems - Exercises and Rehabilitation
1:18:49 Like & Subscribe!
"We just finished our first podcast here at Princeton Spine & Joint Center. It was a really good conversation with my good friend and colleague, Dr. Zinovy Meyler. We really got into the weeds talking about facet joint pain. We talked about what kinds of things you expect to see on history and physical examination, how you diagnose for facet joint pain, the common types of nonsurgical treatment for facet joint pain in the most conservative ways. We really got into an in depth conversation about radio frequency rhizotomy, which is a particular kind of treatment which you'll hear about in the podcast."
~ Grant Cooper, M.D.
I like that you stop and ask these questions and make the comments because they are legitimate and us layman people are wondering and asking ourselves the exact thing you keep asking him! Don't say sorry for it because that is why we watch this is to have those things answered and understand why the answer is that way.
*There is mild disc narrowing not spine column narrowingat C5-C6.
Drs. Cooper and Merley, I've just finished viewing -- and making notes as I watched -- your Feb. 27, 2019 discussion of facet joint treatment. It taught me that a lot of my ideas about radio frequency ablation were seriously out of date. Tomorrow my insurer will permit me a mere 15-minute consultation with my orthopedic specialist's person assistant. Thanks to the knowledge I gained from your video, I will make maximum use of that time by having a much more positive attitude about RFA, and will be asking her mostly detail questions. Your generously making this conversation has unite possibly saved me from making a big mistake. Words cannot express my gratitude.
Oh, a tip about getting people to exercise. Start the patient off with a simple ten-minute session to be done at the same time every day. Make the the patient promise to stick it out for three weeks. By the end of that time the patient will have gotten into the habit, plus they will be feeling the benefits of that exercise. At that point, they won't want to quit.
Good talk, and very useful when doctors do not normally explain very well, but too many diversions and interruptions in this talk, loses the direction of talk.
This is a good podcast regarding facet joint pain. I’ve gone through physical therapy which was somewhat helpful but didn’t fully resolve my lower back pain. My Pain Specialist is still trying to narrow down what he believes is a form of arthritis. Now the Dr. is recommending a procedure for Lumbar Facet injections to determine if the injections resolve the lower back pain. Apparently this procedure will help narrow down the cause which he believe will confirm the form of arthritis. What I’ve always wanted more details on is the type of pain patient describe. In my case, I usually describe my pain as more a level of heaviness, tightness, etc. of the muscles on either side of the lower/mid back. The pain generally isn’t present when I’m setting or laying down. But as the day progressing, by the time late afternoon rolls around the more tense the areas get.. I believe its because of the weight and pressure put on the facet joints over the course of the day; Generally it is not because of any strenuous activities, but simply the weight and pressure of standing or walking. Anyway, my sincere hope is the injections provide some level of temporary comfort until a longer term solution can be determined because the sensation can be very debilitating. Thanks much.
are you still around Chase? Wondering how you went with the injections/other...?
Lumbar facet arthropathy and congenital lumbar spinal stenosis here. From my lower waist down, I feel like I wake up with concrete attached around me.
The longer the day goes and especially if I'm unable to lay down often and take the pressure off, I will be forced into bed by mid-day. The pain is so intense that it causes me pass out... I cannot watch long movies because I pass out during them. 😔
43 year old male. I orginally hurt my back driving golf balls at 15!! I remember because I had soccer tryouts the next week. wound up never playing soccer freshman year. fast forward to 21 years old. really hurt my lower back doing a good morning weight lifting excersize. I was in bed for a week before I could move. Its safe to to say the last 20 years has been filled with pain. good days and bad days. lately (since 40) it seems more bad days. I am still physical but something as subtle as barely bending over in the morning to brush teeth with drop me to my knees wincing in pain. Finally went to dr. for the very first time for a look. after the mri the dr beleives my pain is coming from the fact joints as there are fluid present. 3 levels right side L 3 4 5. She schedule injections for those facets to see if that helps. I also have degenerative L5 disc with a small fissure and modic changes on the endplate of the bone. she does not think that is my issue. my pain is lower back 1 side with blips off pain in top of butt cheek and groin. sleeping the pain will keep me up and mornings are the worst. I am so my spine has been a pogo stick for 20 years
Great podcast. Love it. I’m suffering from lber facet joint pain right now
Very informative, thank you doctors 👍🏽
I have my biggest problem in bed at night. I am getting an injection next week. Hoping this will help. Definitely hurts during the day, but it’s off the charts at night. I get maybe 3 hours of sleep. (I have had a fusion at s1 and L5 and 4 and 5 over the last 6 years. You are right, in fortunately it keeps moving up.). But I still feel better then before the fusions
I learned a lot from this and I appreciate the deep dive. I had an open Mumford with a Weaver-Dunn in 1991 and a C5/6 fusion in 2011. My original injury was from a fall onboard ship when I was in the Navy. I kept up with my exercises but wear and tear kept up their part also. In 2013 had radio frequency ablation on a nerve that associates with C7. I have taken it easy since then and I haven’t needed any more intervention. My doctor has forbidden me from doing free weights, push ups, pull ups, dips, jumping jacks and one may extrapolate from there. I still have radiculating pain and lots of tingling in other parts of upper left extremity but the excruciating pain in the armpit has not returned.
Radio frequency ablation helped me salvage a ruined life back into a content and manageable one. I don’t recall the procedure hurting. I was awake and in a great deal of pain that I brought with me but I thought my pain was greatly reduced immediately and a few days later I know I felt an abrupt and significant reduction of pain and tingling.
I wish this guy was my doctor
Yeah wish he was mine too!! Thankful for this podcast.
oh-so informative! Thank you
I was diagnosed with facet syndrome, I was treated with pain meds, steroid shot and P. T, followed by chiropractor all which hasn't helped. This is 8 months in and still no change, I am seeing my pcp next month about a fever and after plans are in the works for me to get the injection. I am in pain all day every day, it gets worse the more i walk. I struggle in bed at night much pain, getting up from sitting, using the toilet, taking things out of the refrigerator, just pain. I had an MRI & X-ray. I also have chronic fatigue so sometimes I am unable to do P. T I can't have nsaids because I also have a kidney disease.
Discomfort?? It’s pain, Doc, it’s called pain. Why won’t physicians & folks in medicine in general just admit that even though they try to avoid it, stuff hurts sometimes. Just say yes, it’s gonna hurt a bit, or…it’s gonna hurt like a mother. Tell the dang truth!
When you going to do one just about Rhizotomy, I love this one, thinking about Rhizotomy next time I have a upset of my Facet Joint
Thank you!!!
Platelet rich plasma (PRP) can be very helpful if you find the right practitioners. Unfortunately it’s usually not covered by insurance. I hope more doctors learn prolotherapy and PRP. Unfortunately for most it’s not a long term fix and most have to go back for regular tuneups.
good info , i had 2 "rfas " years ago and didnt have a great result , no nerve blocks , or investigation , in and out of the room within 10-15 min . starting to realize how shady those doctors prob were . had a nerve block with much better results couple days ago so its promising this time around
Great information provided here and very useful for my understanding of facet joint pain. However you guys were so giddy at times it was hard to absorb the information provided...just an observation...👌
I gave up listening and came to comments to get more info..!!
It really is amazing that professionals never even consider the use of high absorption Turmeric as a strong anti imflammatory. They knee jerk go to the steroids that have terrible side effects. I know dozens of people taking turmeric with clear results that it is a very effective tool to manage irritated nerves and just about anything inflamed. Yet professionals shy away because the medication industry sees no money in Turmeric (and therefore have not funded formal large Turmeric marketing and research campaigns).
Is there a certain brand you recommend?
I learned a lot from this video. Great discussion.
Thank you for this very informative presentation.
Curious manner.
High jocularity about a painfully serious topic. Enlightening overall.
Thank you for a very informative podcast! I had a bilateral RFA for neck pain in January 2023 after we did the three test blocks. It only lasted about 6 months. What would be next?
Hello,I have lumbar facet joint arthritis and herniated disks at L4 S1 and further up,I broken my spine at L5 with retropulsed fragments into my spinal canal causing spinal stenosis at that level.I also have thecal sac compression and facet joint arthritis with osteoarthritis.Also I have compression fractures from L4 to T11, my spine hurts all the time,especially when I lie on it the pressure build up and pain is awful,I have being mentioned for a radiofrequency albation,would this allow me to get a good night's pain free sleep?Sorry for the long post.
How do they know which specific facet joint in the lumbar spine ,if a scan is non descriptive, to actually burn.? No one would know would they.?
That's a great question, Ian. Thank you for bringing it up. It turns out that different facet joints have different predictable pain referral patterns. That doesn't let you know exactly which facet joint is causing your pain, but it helps narrow it down. Then, the way you figure out which joint it is, is by selectively blocking the joint and seeing how the patient responds. In a research center, the way this would work is that you would come in with back pain and we would block ONE joint. You would go home with a pain diary and record how you felt . If blocking that joint took away all or all of one geographic portion of your pain, then we know that one joint is responsible for that portion of the pain. And there are typically three or four (depending on the region) different facet joints that have overlapping pain distributions to work through to figure it out. In the real world -- that is in clinical world -- we typically block two or even three joints at a time. If the pain goes away, it's possible (and perhaps probably) that one of those joints is innocent, but in the interest of not making the patient return to the clinic too many times, we block multiple joints at the same time and then burn them together as well. We can do this because there is such a negligible downside of the RF procedure. In clinical practice, this is typically how it is done. I spent time at a famous research institute in Australia and there we would block one facet joint, send the person home, and then block the next joint the next day. It was academically more rigorous to be sure but it was also a fairly large burden on the patient who had to keep coming back several times. Thanks again for watching and for your question!
@@PrincetonSpineJointCenter Thankyou for that comprehensive reply and for all you people do to alleviate this problem. I myself have been told I have facet joint arthritis (Oswestry orthopaedic) and found your podcast extremely interesting and informative. Don't think they offer that 'burn' treatment there.
Great video
Thank you but actually I have had a long long-term severe problem with this in my thoracic spine from being an artist.. it is very tough because when you can't use your arms and hands without pain how do you get along? Lots of breaks, lots of things you can't do like everybody, periods of total disability not to mention the pain
Just one question does this block the arthritis pain and stiffness sensation? Or it is just blocking nerve pain?
I came for the discussion, almost didn’t get past the theme music...😆
So after the rhizotomy, the facet bones are still grinding together and wearing down, but we just cant feel it anymore? Isn't the integrity of the bones constantly degrading even after the surgery?
Zach, this is a great point and question. It would be very reasonable to think that burning the sensory nerves to the facet joints so that you don't feel the pain could lead to more damage to the joints or some other sort of unforeseen problem. For knee osteoarthritis and knee pain, you can perform a radiofrequency rhizotomy as well but one of the very real concerns is that if you don't feel the damage being done to the knee, wouldn't that or couldn't that lead to further damage. In the knee, this is a concern that I have for otherwise fairly healthy knee joints and I think the jury is still out in terms of seeing long-term follow up data. However, for the facet joints, we have 30+ years of follow up data to support the idea that it doesn't. It turns out that with the facet joints, the signal of pain is just not helpful to the long-term health of the spine. This doesn't mean that you shouldn't still be doing exercises to support your spine and maintaining good spine hygiene. But it does mean that feeling the pain from facet joints is an unnecessary burden that doesn't seem to do anything for the health of your spine.
@@PrincetonSpineJointCenter Interesting. Thank you very much for sharing your expertise on these subjects.
I have disc endplate problems and facetpain.
I wonder if the intracept procedure works for me
I’m wondering the same thing! But now I’m hearing they don’t offer sedation during the procedure. That’s probably makes it a “no go” for me. I’m a big baby when it comes to sharp things penetrating my back.
We do Intracept at my clinic but intracept is always done with it sedation for our patients. It would be comfortable during the procedure.
Will that procedure help you? Typically if you have inflammatory endplate changes that associate with pain with forward flexion or sitting for extended periods of time. Just thought I’d help out a little bit.
I've had 2 epidurals on r month apart. They don't seem to be working for my facet joint arthropathy.
Now what ?
Oblation is great
I want to get the Oblation..How did u go about it?
Did this eliminate your pain?
Yes..was like some turned off a light switch!!!! I haven't taken as much as a Tylenol since the oblations. I slept 10 hours after it, because of no pain. Very pleased. I found a well educated group of very experienced anesthesiologists that do these procedures daily in thier pain clinic.
7 months and still doing very well
@@PetsNPatients that's awesome!! I find out next week if I'm going to have it done!
More visuals, bit repetitive
To say that "theres no downside ti have it repeated" is irresponsible given the long term impact of repeating.