Osteoarthritis and Facet Joint Problems: Doctor Answers Patient Questions

Please understand that the following responses to questions about osteoarthritis, spinal arthritis and facet joints represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Movement may help osteoarthritis and joint pain

Question:

My wife has low back pain only when lying down in bed at night. Her back feels the same in any position; nothing seems to relieve or increase the pain. She also has pain in the morning when she wakes up. No pain during the day. Can you tell me what this might be? She is active and 41 years old.

Doctor’s response:

Your wife’s pain may be from osteoarthritis of the facet joints in the back, or some other sort of joint dysfunction. If there is pain in a joint, sometimes movement helps decrease it by lubricating the joint. Laying still allows it to ache more. Mostly, manual treatments such as physical therapy or chiropractic tend to be good for this type of pain. However, prior to starting any further treatment, your wife should be seen and evaluated by a spine specialist (e.g. physiatrist or orthopedic surgeon/neurosurgeon).

Ongoing mechanical back pain and joint dysfunction

Question:

I have had tolerable back pain for many years. It has gotten progressively worse over the years. I started to see a chiropractor in January. He provided some relief but I stopped in April due to a work schedule. Sometime in late May, I started to experience massive pain in my left toes. My back pain is on my left side, and the pain is so intense I almost pass out.

I had a meeting with a neurologist who tested my reflexes and then sent me for an EMG test, which resulted negative. I had X-rays of my feet and left side by both an arthritis specialist and orthopedic surgeon. I also had an MRI done, which resulted as follows: disc bulge is seen at L2-3 with mild degree of canal narrowing. The L3-4 level demonstrates Grade I retrolisthesis. I have a mild degree of canal stenosis. The L4-5 level demonstrates degenerative endplate changes with Grade I retrolisthesis with disc bulge.

I returned to chiropractic care in June and experienced more pain than I could handle and stopped the care. I started to take two drugs, Celebrex (200mg) and Neurontin (300mg) in July and was pain free until I started minor exercise therapy. Now the pain is back with a vengeance, and I stopped the therapy this week.

The pain comes in any position, sitting, standing, lying down in bed or walking. It is inconsistent, without warning, at any time of day. The pain is off the charts, I can only say it feels like touching my toes to an exposed electrical wire. I am about to take a small regiment of Prednisone as prescribed by my doctor. Please steer me in the right direction. Who do I see next?

Doctor’s response:

The pain you are describing sounds mechanical in nature. Pain that comes and goes is often related to joint dysfunction. It can be very frustrating and difficult to both accurately diagnose and treat. The only specific finding on your MRI scan may be the anterolisthesis of L3 on L4. If this is also associated with foraminal stenosis, you could be having some nerve root pinching which could account for your leg pain.

Mechanical back pain and joint dysfunction are usually best handled with joint manipulation and exercise. Your treatment so far sounds appropriate, but you may want to try a different manual therapist (a physical therapist with manipulation training, a different chiropractor, or an osteopathic physician). It is encouraging that for a period of time you were pain-free. Be patient, and expect to go through setbacks as you continue your rehabilitation.

If you fail to make progress with rehabilitation, you should be seen and evaluated by a spine specialist to see if there is any significant nerve root pinching that can account for your pain. If there is a pinched nerve, you may be a candidate for an injection or possibly a surgical decompression.