Outcomes of lumbar facet syndrome treated with oral diclofenac or methylprednisolone facet injection: a randomized trial
- 370 Downloads
This prospective randomized trial is to determine the effectiveness of treating lumbar facet syndrome with oral diclofenac, methylprednisolone facet joint injection or both.
We enrolled lumbar facet syndrome patients treated at Srinagarind Hospital. Enrolled patients were randomly assigned to receive 100 mg/day oral diclofenac, an 80 mg injection of methylprednisolone into each symptomatic facet joint, or both. Endpoints were the Oswestry disability index (ODI) and visual analogue scale (VAS) before treatment, and at four and 12 weeks after treatment.
Of the 99 patients, the mean age was 46.4 years and 48 were men. The initial ODI (mean ± SD) for the diclofenac, methylprednisolone and combined treatment was 45.1 ± 9.3, 42.9 ± 15.6, and 42.2 ± 11.5, respectively. The respective four week ODI was 30.1 ± 8.1, 20.2 ± 8.0, and 15.1 ± 5.5. The 12-week ODI was 42.4 ± 9.0, 32.2 ± 15.6, and 26.2 ± 11.7. The initial VAS was 7.1 ± 1.2, 7.6 ± 1.1, and 7.3 ± 1.0. The four week VAS was 5.3 ± 1.4, 3.6 ± 0.7, and 3.3 ± 1.1. The 12-week VAS was 6.1 ± 1.1, 5.8 ± 1.4, and 5.1 ± 0.9. The four week ODI and VAS for the combined treatment and the methylprednisolone treatment were significantly less than the diclofenac alone. The combined treatment also showed better scores than the methylprednisolone injection. Within each treatment, the best treatment effect was found at four weeks after which the ODI and VAS gradually increased but were still less than the initial scores.
The combined treatment was more effective in reducing lumbar facet pain and improving the functional index than either treatment alone. This approach should be the preferred treatment.
KeywordsDiclofenac Facet joint Facet joint injection Low back pain Methylprednisolone Zygapophyseal joint
The study was supported by the New Researcher Grant, Khon Kaen University, Khon Kaen, Thailand. The authors would like to acknowledge Mr. Bryan Roderick Hamman and Mrs. Janice Loewen Hamman, for editing the manuscript via Publication Clinic of Khon Kaen University, Thailand.
Compliance with ethical standards
Conflict of interest
The authors have no competing interests.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No benefit(s) in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
This is original work from the Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Thailand, and it has not been presented elsewhere nor under consideration by another journal. The authors participated in the design, execution, analysis and writing up of the research.
- 11.Sae-Jung S, Hunzawong T, Jirarattanaphochai K (2002) Reliability of Thai version of Oswestry quesionnaire for the evaluation of low back pain patients. Srinagarind Med J 17:247–253Google Scholar
- 22.Freiermuth D, Kretzschmar M, Bilecen D, Schaeren S, Jacob AL, Aeschbach A, Ruppen W (2015) Correlation of (99m) Tc-DPD SPECT/CT scan findings and diagnostic blockades of lumbar medial branches in patients with unspecific low back pain in a randomized-controlled trial. Pain Med 16:1916–1922CrossRefPubMedGoogle Scholar
- 32.Chambers H (2013) Physiotherapy and lumbar facet joint injections as a combination treatment for chronic low back pain. A narrative review of lumbar facet joint injections, lumbar spinal mobilizations, soft tissue massage and lower back mobility exercises. Musculoskeletal Care 11:106–120CrossRefPubMedGoogle Scholar