Pinpointing the pain

OH, your achin’ back. It can happen lifting something heavy, or simply reaching for a book. About 85% of adults suffer low back pain at some point in their lives. For most, the pain resolves in a few weeks. For others, it can be long lasting and difficult to treat.

Now researchers have found a way to help identify the approximately 20% of back pain patients who might be helped by facet joint injections. These steroid and anesthetic injections to the small joints of the spine are out of favor with many physicians because they don’t help the majority of patients.

But Dr. Spiros Pneumaticos, professor of orthopedic surgery at Baylor College of Medicine in Houston, found that a bone SPECT imaging scan (single photon emission computed tomography) can identify patients who can benefit from the shots. The scan can also help pinpoint, better than X-ray or MRI, exactly where the shots should be given.

He studied 47 men and women with low back pain who were scheduled for facet joint injections, then randomly divided them into two groups. One group received a bone SPECT. Those whose scan showed the shot would help got the injection at the indicated site. All others got the shot at the site their physician thought might work. A month later, patients whose scan results were positive had better pain reduction than the other groups.

“This is a small answer to a big puzzle,” Pneumaticos says. “It may help a portion of patients.”

The study was published in the February issue of Radiology.