Although the existence of a "facet syndrome" had long been questioned, it is now generally accepted as a clinical entity. Depending on the diagnostic criteria, the zygapophysial joints account for between 5% and 15% of cases of chronic, axial
low back pain. Most commonly, facetogenic
pain is the result of repetitive stress and/or cumulative low-level
trauma, leading to
inflammation and stretching of the joint capsule. The most frequent complaint is axial
low back pain with
referred pain perceived in the flank, hip, and thigh. No physical examination findings are pathognomonic for diagnosis. The strongest
indicator for lumbar facet
pain is
pain reduction after
anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Because false-positive and, possibly, false-negative results may occur, results must be interpreted carefully. In patients with injection-confirmed zygapophysial joint
pain, procedural interventions can be undertaken in the context of a multidisciplinary,
multimodal treatment regimen that includes
pharmacotherapy,
physical therapy and regular exercise, and, if indicated, psychotherapy. Currently, the "gold standard" for treating facetogenic
pain is radiofrequency treatment (1 B+). The evidence supporting intra-articular
corticosteroids is limited; hence, this should be reserved for those individuals who do not respond to radiofrequency treatment (2 B±).