How to Treat Facet Joint Disease

What is Facet Joint Disease?

Facet joint disease is an inflammation of the joints along the spine. This inflammation can be extremely painful, limiting a patient’s quality of life. Fortunately, this condition can be treated in a number of ways that don’t involve the use of addictive painkillers.

What are Facet Joints?

Facets are located on both sides of every vertebra (bone) in the spine. The cartilage within them allows the bones to slide freely over one another. Facet joints are surrounded by a protective sleeve called a capsule, which is lubricated by joint fluid. “Facet joints do more than just hold the spine together; they allow your back to twist and enjoy a range of motion,” says Dr. Prasad Lakshminarasimhiah, pain management specialist at Physician Partners of America in Frisco, Texas. “When these joints degenerate due to aging or trauma, they can become inflamed and cause great pain.”

Symptoms of Facet Joint Disease

This condition goes by different names: facet syndrome, facet arthritis, facet hypertrophy, and spinal osteoarthritis. By any name, it can be excruciating and affect everyday life. It should be properly evaluated and treated.

Facet Joint Disease Symptoms

Facet joint disease is more commonly found in the areas of the spine where there is more movement. It usually occurs in the neck and lower back but can also affect the mid back. It is important to note that not everyone with facet joint disease experiences pain; they might not know that they even have it. Those whose symptoms fall on the mild end of the spectrum might experience some stiffness and discomfort.

More severe symptoms include major inflammation and painful swelling. If facets in the upper portion of the spine are affected, it can cause head, neck or shoulder pain. If facets in the mid to lower spine are impacted, it can cause radiating pain in the lower back, buttocks or legs. Left to progress, facet disease may lead to bone spurs, cysts or thickened ligaments as the body tries to protect the joints from the effects of inflammation.

Conservative treatment for facet disease

Conservative options might be enough to relieve the pain in people with mild facet disease symptoms. Many specialists will recommend a combination of rest, physical therapy, a home exercise program, and medication to reduce inflammation. 

People with moderate to severe facet disease, or whose symptoms have not responded to physical therapy, may need interventional treatment options. After such treatment, patients who engage in a regular home exercise program and follow the proper mechanics of lifting and bending are likely to experience longer pain relief.

Laser procedures to treat facet joint disease

“At Physician Partners of America, our treatment philosophy is to minimize body trauma for a faster recovery,” says Dr. Lakshminarasimhiah. “To achieve this, we use the most advanced minimally invasive procedures to help patients regain their quality of life as quickly as possible.”

One tool board-certified pain specialists may choose to use is the Holmium YAG laser. It treats pain-causing nerves with less disturbance to the surrounding muscle and tissue than the scalpels used in open surgery. Dr. Lakshminarasimhiah and other PPOA specialists start by making a 2-3 mm incision at the treatment site. Guided by live x-ray, they insert very narrow instruments into the treatment area. The laser is then threaded through the tube and used to ablate the nerve that is causing pain.

With this minimally invasive procedure, the patient will experience the least amount of tissue damage and enjoy a faster recovery. Most people simply walk out of the ambulatory surgery center and heal in a matter of days or weeks.

“The good news is that we can definitely treat facet joint disease without the use of prescription painkillers,” says Dr. Lakshminarasimhiah. “Finally, people can free themselves of back pain and opioid medication.”

What is the best treatment for facet disease?

Every patient is different, and symptoms can range from undetectable to crippling. If you are experiencing symptoms that interfere with your everyday life, get a full evaluation by the board-certified pain management specialists at Physician Partners of America.

Top 5 Conservative Remedies for Spinal Stenosis

What is Spinal Stenosis?

Spinal stenosis is a condition in which the passageway where a nerve root exits the spine becomes too narrow and compresses the nerve. This leads to a “pinching” of the spinal cord and/or nerve roots and can become a very painful back condition affecting everyday life.

Nerve compression can be caused by bone spurs, bulging discs or thickened tissue. It is most often due to age and injury. Many times it can be treated with conservative remedies for spinal stenosis.

Symptoms of Spinal Stenosis

The most commonspinal stenosis symptoms includes a sharp pain that radiates down the leg, as well as cramping, weakness or numbness.

spinal stenosis treatment

Spinal stenosis is usually diagnosed by a neurosurgeon, orthopedic specialist or pain management physician. The diagnosis is usually based on symptoms, medical history, a physical examination and test results.

How to Relieve Spinal Stenosis

Exercise– Engaging in a regular, doctor-approved exercise program can help take the pressure off the pinched spinal nerves and adjust the position of the spine. If done correctly, exercise may alleviate the pain. 

A common exercise sufferers can do at home to reduce pain is standing lumbar flexion. To do the exercise, stand with feet apart and slowly bend forward, reaching toward the floor. When the back is fully bent for 2 to 3 seconds, slowly return to the upright standing position.Whenever you feel increased back pain or leg tingling, simply repeat this exercise a few times to help alleviate your symptoms.

Medications for Spinal Stenosis – A doctor may prescribe oral medicines such as NSAIDS, antidepressants, anti-seizure, and opioid painkillers. Over-the-counter pain relievers might provide temporary relief but they are not usually recommended long-term. Opioids are effective for very short-term relief of acute pain, but they have well-known dangerous side effects including addiction, brain and liver damage, constipation and depression.

A board-certified pain management specialist can treat the pain directly with nerve blocks and cortisone injections. Theseconservative remedies for spinal stenosis can provide long-term relief.

Physical Therapy for Spinal Stenosis – Many people with spinal stenosis attempt to reduce the pain by reducing their movement. This can actually lead to more pain due to the weakening of the muscles. Physical therapy can help relieve pain by helping patients stay active and move correctly. Physical therapists work with patients on proper movement and lifting techniques, which are major contributors to lower back pain.

Massage Therapy or Chiropractic Care – Spinal adjustment can help return the vertebrae to a more optimal position and increase range of motion. This may relieve symptoms such as pain, muscle spasms, or tightness. Effects are temporary and readjustment must be done regularly.

stenosis of the spine

Holistic Therapies – Some patients find it helpful to not only treat the affected area, but the body as a whole. To do this, some look toward acupuncture, acupressure, yoga, nutrition and diet changes, meditation and biofeedback to reduce their symptoms and improve their overall health.

Minimally Invasive Spine Procedures for Spinal Stenosis

If conservative remedies for spinal stenosis don’t prove effective, surgical treatment for severely compressed nerveshas come a long way from traditional open back surgery.Small-incision outpatient procedures have proven effective for relieving spinal stenosis quickly. This technique allows patient to walk out the same day and recover in days or weeks instead of months.

Spinal stenosis can severely impact quality of life. Treating it early is the key to a full recovery. Physician Partners of America offers both conservative pain management and procedural options that offer customized relief for spinal stenosis.

Lumbar Spinal Stenosis Treatment Options

The symptoms of lumbar spinal stenosis (LSS) are pretty clear: severe pain when walking more than 50 feet, and relief when bending over or sitting. And the cause is usually clear-cut, too; it’s another sign of aging.

The good news is there are effective outpatient surgical procedures available when physical therapy, chiropractic and other conservative measures have failed to ease the pain of spinal stenosis.

What is Lumbar Spinal Stenosis?

LSS is a degenerative condition that typically comes from a lifetime of the lower spine supporting the supper body. As people age, the discs between the vertebrae, or spinal bones, become worn down. This causes the spinal canal to slowly narrow, effectively squeezingthe nerves that exit the spine. This pressure often leads to tingling, numbness, or sciatic nerve pain that radiates to the buttock, leg and groin. It can be excruciating.

Lumbar Spinal Stenosis Back Pain Treatment

People with LSS typically cannot walk father than 50 feet without feeling this pain and find relief when sitting down or leaning forward. A typical scenario is the older person at the grocery store hunching over a shopping cart to relieve the pain.Left untreated, muscle weakness, loss of reflexes, and sometimes a condition called foot drop can develop.

The goal in treating LSS with surgery is to gently widen the narrowed opening in the spinal canal, giving the spinal cord and nerves more room to function normally. While injections of numbing medication can keep the pain away for a certain period of time, sometimes surgery is the best option.

Minimally Invasive Spine Surgery (MISS)

Skilled surgeons no longer need to treat low-back stenosis with traditional open back surgery, which involves a 5- to 6-inch incision and the cutting of muscles to reach the spine. Instead, specialists can use narrow dilation tubes that spread muscles like a curtain, and tiny endoscopic instruments outfitted with cameras. This approach avoids damage to muscle and tissue.

“A cut or torn muscle is essentially damaged forever. It becomes weak and never functions the same way again,” says Dr. James St. Louis, an orthopedic spine surgeon with Physician Partners of American Minimally Invasive Spine Group. “In minimally invasive spine procedures, the muscle fibers are left intact. There’s less bleeding and pain, and the recovery is days or weeks, not months.”

A laser maybe used in these procedures to ablate pain-causing nerves and shrink bulging discs that cause spinal stenosis.

Foraminotomy – This procedure increases the width of the intervertebral foramen, or opening between a pair of vertebrae in the treatment area. A small tool called a Rongeur is used to remove small slivers of spinal bone.It allows more room for the exiting nerve and alleviates the painful compression.Thisis a minimally invasive outpatient procedure that requires only two or three stitches and allows the patient to go home the same day.

Laminotomy – This procedure targets the lamina, the bony cover of the spinal canal. The surgeon removes a small part of the lamina to relieve pressure on the nerve exiting the spinal cord. In experienced hands, this procedure will not harm the structure of the spine.

Interspinous Process Spacers for Lumbar Spinal Stenosis

Another alternative to traditional surgery is a spacer, which helps keep spinal bones separated while the patient is standing. This small device, implanted by an experienced surgeon, relieves pressure on the spinal nerves. Its effectiveness has been validated by years of clinical research and is FDA approved.

While the idea of “back surgery” may seem scary, minimally invasive procedures are nothing like traditional open back surgery. They are highly effective and safe, allowing the patient to walk out of the surgery center the same day and heal quickly. Most people report a steep reduction in pain and some are immediately pain free.

Spinal Cord Stimulation Can Relieve Arachnoiditis

Arachnoiditis is not related to spiders, but one of its symptoms is a creepy-crawly sensation. It is a rare condition of a web-like spinal membrane that is difficult to treat; however, spinal cord stimulation is proving to be a highly effective to relieve arachnoiditis symptoms.

With only about 11,000 cases diagnosed each year, this condition causes scarring of the layers surrounding the spinal nerves. Inflammation causes the nerves to stick together and create scar tissue, which presses against the nerve roots that exit the spine.

What Does Arachnoiditis Feel Like?

The condition presents differently in everyone. It can be as mild as a creeping skin sensation or as severe as muscle cramps and spams or sharp electric shock-like pain. In some people, it can cause bladder, bowel or sexual problems.“Sometimes the same patient can have all these symptoms at once or at different times,” says Dr. Abraham Rivera, Chief Medical Officer of Physician Partners of America in Tampa. “It’s the kind of condition that few doctors ever encounter.”

Arachnoiditis treatment

Arachnoiditis is commonly linked to impurities that enter the fluid surrounding the spinal column. This can happen accidentally during medical procedures like spinal taps, myelograms and epidurals. It can also be a unique reaction to preservatives used in certain injectable medicine.

New Ways to Treat Arachnoiditis

Prescription opioid medication has been a go-to treatment for arachnoiditis pain relief, but the side effects of a systemic treatment can outweigh the temporary relief. Interventional pain management specialists, who treat the root of pain conditions, have found greater success with spinal cord stimulation (SCS). Also known as neurostimulation, this treatment delivers a mild electrical current to the affected area. This current serves to counter the pain signals to the brain with a light tingling.

Spinal cord stimulators are implanted in a minimally invasive procedure performed outpatient, meaning the patient can go home the same day. The devicecombines a thin, flexible lead attached to a small generator placed under the skin. The patient controls the intensity of the stimulation using a handheld Bluetooth device. Some generators are changed out every few years, but the newest models are externally rechargeable.

How Does Spinal Cord Stimulation Work?

Spinal cord stimulation therapy begins with a trial period:temporary electrodes are put in place using careful x-ray guidance, and the patient controls the current using an external device.

If both patient and physician agree that the trial offers adequate pain relief, the permanent device is implanted in the nerve fibers of the spinal cord. The generator is placed under the skin in the abdomen or lower back, and the two are connected with an extension wire.

Spinal cord stimulators are one of the few fully reversible chronic pain treatments. A skilled physician can remove the lead and generator in a short outpatient procedure. The lead is threaded down the spine in the epidural space, and the generator is placed under the skin in the lower back. The two are connected by a thin, flexible extension wire. The patient may be awakened briefly during the procedure to make sure the right nerves are being targeted.

Spinal cord stimulation is successfully used to treat many other severe, chronic pain conditions, such as lasting pain after back surgery (failed back syndrome), peripheral neuropathy and complex regional pain syndrome. Results also show promise for arachnoiditis,

“For the right patient, spinal cord stimulation can successfully treat the symptoms associated with arachnoiditis,” says Dr. Rivera.

Social Security Coverage for Spinal Stenosis

Social Security Covers Spinal Stenosis?

If you experience spinal stenosis and are unable to work, you may be eligible for Social Security disability benefits. The Social Security Administration (SSA) offers monthly disability benefits for people who are no longer able to work due to a serious illness. The good news for you is spinal disorders are some of the most commonly approved conditions. Continue reading “Social Security Coverage for Spinal Stenosis” »

How Sleep Deprivation Impacts Back Pain

Even though the average adult needs seven to eight hours of sleep, many people struggle to get that many hours in because of pain. Rest can become even more difficult because a lack of sleep influences both pain levels and the effectiveness of pain medications.

While pain perception varies from person to person, it can also change based on sleep quality and quantity. Researchers have tested the theory that sleep loss affects pain perception in a number of different studies, including one that compared pain sensitivity between a group of people that got nine hours of sleep and another got seven. Technically, both groups got an adequate amount of sleep, yet the group that increased their sleep time showed a 25 percent higher pain tolerance. Other studies have compared pain sensitivity between groups that got half the recommended amount of sleep or got no sleep at all. Every study showed that, in general, as the amount of sleep goes down the body’s sensitivity to pain goes up.

Pain tolerance isn’t the only way that sleep deprivation affects back pain. It also influences the body’s response to pain medication.




A study published in Experimental and Clinical Psychopharmacology explored the impact of sleep on the effectiveness of codeine. All participants took codeine but only half got a full night’s rest. Those who didn’t get enough sleep did not tolerate pain as well as those who did. Because lack of sleep increases pain and reduces the effectiveness of pain medications, sleep becomes more than a luxury and enters the realm of being a partner in pain management.

Everything from daytime habits and behaviors to bedroom conditions can influence sleep and, therefore, back pain. To provide the best chance at getting a good night’s rest, the right products and equipment need to be in the bedroom. For example, a mattress that supports your back and preferred sleep style can reduce wakefulness. A dark, quiet bedroom can help keep outside noises and distractions from interfering with sleep.

Behaviors and habits that support good sleep can also become part of reducing back pain. For many people, getting better sleep means developing a consistent sleep schedule. Going to bed at the same time every night and waking up at the same time each morning helps the body correctly time the release of hormones. For those who find it difficult to fall asleep, a bedtime routine can make a big difference. It gives both mind and body a chance to relieve stress while triggering the release of sleep hormones.

Diet can also influence the sleep-wake cycle. High-fat, heavy foods eaten close to bedtime can disrupt digestion and be uncomfortable. Caffeine and other stimulants eaten within four hours of bedtime can block sleep hormones. However, there are foods that promote the production of sleep hormones like dairy products, almonds, and bananas that make good late-night snacks.

Exercise can also affect how well you sleep. Regular activity wears the body out so it’s more tired at night. It also helps with weight management, muscle strength, flexibility, and endurance, all of which can help reduce back pain. Those who suffer from back pain should consult a physician to find appropriate exercises for their age, weight, and pain issues.

A focus on high-quality sleep may not eliminate back or neck pain, but it can certainly help bring it to manageable levels and allow pain medications to take full effect.

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The best tips for managing chronic back pain

gut health back pain probiotics for ankylosing spondylitis and rheumatoid arthritis

Photo via Pixabay by Whitesession For the millions of Americans who are living with chronic pain every day, it can be difficult to find the right coping methods for sustainable living. Link to this post!

5 Tips for Exercising with Scoliosis

If you are living with scoliosis, exercise is a fantastic way to strengthen your muscles and ease the pain that comes with a curved spine. Not every exercise is great for your scoliosis, and you must be careful about the kind of workout you do. These five tips will help you keep a fit, healthy body and live life to the fullest. Continue reading “5 Tips for Exercising with Scoliosis” »

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Back Pain – Is it a Tumor?

spinal cancer back pain symptomsSpinal cancer is not the typical diagnosis when back pain strikes, but there are some symptoms that are red flags for a tumor or tumors in the spine. Spotting cancer early gives you the best chance of success, but due to the varying symptoms of cancer in the spine, and the relatively frequent occurrence of uncomplicated back pain, many people are not diagnosed until a tumor has already become quite large or metastasised.

If back pain persists, worsens, and is unresponsive to rest and conservative treatment, and is accompanied by the following symptoms, it is definitely time to talk to your physician about tests for cancer. Continue reading “Back Pain – Is it a Tumor?” »

Pain Management Options for Spinal Stenosis

Spinal stenosis is a very common ailment for people the world over and the pain can range from uncomfortable to intolerable. No matter what level of pain you experience with spinal stenosis, you will undoubtedly be in search of a way to treat it. Naturally, as it is such a common occurrence, there are a number of different treatment methods that you can try out yourself ranging from medication to more holistic approaches. Continue reading “Pain Management Options for Spinal Stenosis” »