facetjoint pain Lower back pain
Conditions
Interventions
18F FDG PET/MRI 
Sponsors
Erasmus MC, Universitair Medisch Centrum Rotterdam
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: Age between 18 and 65 years Isolated lumbar facet joint related pain: Localized unilateral or bilateral low back pain No radicular symptoms Pain provoked or worsened by unilateral pressure on the facet joint or the transverse process Pain during extension, lateral flexion, or rotation toward the ipsilateral side Muscle hypertonicity at the level of the affected facet joint Referred pain in the leg remains limited to above the knee On palpation: local unilateral movement reveals restricted mobility or increased stiffness on the side of the painful facet joint Pain is relieved by flexion More than 3 months pain No improvement of symptoms after at least three months of conservative treatment according to the Dutch guidelines for non-specific low back pain (GP care (advise to stay active and pain medication) and exercise therapy) in primary care. NRS scale of 6 or higher based on the average pain intensity of the past week Eligible for diagnostic facet block Eligible to undergo FDG PET/MRI Capable of participating in the study
Exclusion criteria
Exclusion criteria: Mechanical pain related to the intervertebral disc or sacroiliac joint Neurogenic pain: radicular pain or pain related to spinal canal stenosis Myofascial pain as the predominant pain component Lesion or disease of the somatosensory system Widespread pain Prior spinal fusion, facet joint treatment, or local surgery Contra-indications for FDG PET/MRI BMI ³35 kg/m2 Systemic disorders: inflammatory, metabolic, cancer Severe psychological problems (determined with psychological questionnaires) Opioid addiction as assessed by the clinical judgment of the treating physician, with particular consideration for patients using more than 60 mg oral morphine equivalents per day Coagulopathy or anticoagulant drug therapy that cannot be discontinued
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Assess the difference in proportion of patients with positive diagnostic facet block between groups. | — |
Secondary
| Measure | Time frame |
|---|---|
| Assess the difference in pain reduction at one, 3, and 6 months after treatment between groupsDetermine number needed to treat at 3 months after treatmentAssess differences in perceived recovery, patient satisfaction, quality of life, and changes in pain medication at 3 and 6 months after treatment between groups.Assess the proportion of patients with changes in clinical management other than the expected facet intervention in the intervention group.Evaluate the proportion of patients with peripheral or central sensitization.Investigate the relationship between FDG PET, contrast-enhanced MRI, and inflammatory serological markers.Perform a health economic evaluationAssess the diagnostic performance of FDG PET/CT compared to FDG PET/MRI in patients with facet joint-related low back pain | — |
Countries
Netherlands
Contacts
Public ContactR.A. Heijden van der
Erasmus MC, Universitair Medisch Centrum Rotterdam
Outcome results
None listed