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Introduction
According to authors, low back pain (LBP) is responsible for more years lived with a disability than any other disorder (Vos et al., 2012). Several anatomical parts in the lower back are associated with LBP, like muscles, fascia, intervertebral discs, ligaments, and facet and sacroiliac joints (Manchikanti et al., 2001, 2015). According to biomechanical studies and controlled studies with facet joint injection (FJI), facet joints are considered the most usual location of pain, with about 40% of the LBP cases (Datta et al., 2009; Falco et al., 2012).
Anatomically, facet joints are structured in superior articular processes paired with inferior articular processes of adjacent vertebrae that allow spine flexion and rotation. The nerve endings from medial branches of the dorsal rami innervate the facet joints (Cavanaugh et al., 2006; Bogduk, 2010; Manchikanti et al., 2013). Authors have been proposed that degeneration of the facet joint may result from combined asymmetrical motion with spondylolisthesis, analogous the other synovial joints (Eubanks et al., 2007; Kalichman et al., 2008; Maataoui et al., 2014). Therefore, the rationale for the basis of facet joint pain is the presence of an osteophyte impacting on a nerve, a stretching of the joint capsule, constricting of synovial villi of articular surfaces, and inflammatory chemicals released in facet joint (Igarashi et al., 2004; Gellhorn et al., 2013; Kras et al., 2014).
For the management of lumbar facet joint pain, in particular pain that is unresponsive to conservative therapy, FJI has been suggested (Manchikanti et al., 2010) for diagnostic examination (symptomatic/asymptomatic facet joint differentiation) and for pain management in patients with painful facet joint syndrome (Kelekis et al., 2005; Falco et al., 2012; Filippiadis et al., 2014; Santiago et al., 2014). The rationale for the indication of FJI is that the injection of corticosteroids has been shown to be effective in the short term (4 weeks) at producing benefits for a range of musculoskeletal disorders in other joints (Zhang et al., 2005; Bellamy et al., 2006). The pain relief may facilitate exercises designed to improve muscular strength and range of movement on lumbar spine (Chou et al., 2011). FJI may be useful in symptomatic spondylolysis (Kang et al., 2018).
It is well-known that persistent LBP is associated with biopsychosocial factors. In patients with pain...