Performed by – Sarmad Kazzaz

There is a different therapeutic modality (form of treatment) for the management of more chronic facet joint pain. If intra-articular injections are of benefit but only on a temporary basis then an alternative means of reducing pain transmission of the facet joints is to block, stun, freeze or burn the small nerves which carry pain messages from the facet joints to the brain. This can be done locally in the spine by injection techniques and does not require any form of surgical incision.

It is important to realise that this process which is called denervation only interferes with the transmission of pain impulses from the facet joint as the small nerves which supply the pain messages only carry pain sensations. They do not carry impulses required to make muscles contract nor do they supply sensation in other vital organs such as the bladder or bowel.

Interrupting these nerves pathways by the technique of denervation is often very effective giving patients significant pain relief (i.e. defined as greater than 50% pain reduction) in about 2/3rd of patients.

It is associated with very few potential side effects if accomplished under x-ray control and can be considered the treatment of choice short of surgery. If the nerves are “stunned” then most patients will experience between 10 and 12 months benefit and this may be prolonged by burning the nerves. Burning the nerves is not always the treatment of choice in the initial stages as although it is associated with prolonged benefit (averaging 2.5 years) there is a slightly enhanced risk.