|Year : 2016 | Volume
| Issue : 1 | Page : 19-22
Evaluation of the relationship between age, gender, and body mass index, and lumbar facet joint pain
Arman Taheri1, Abbas Moallemy2, Amirhossein Dehghanian3, Pooya Vatankhah4
1 Department of Anesthesiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Hormozgan University of medical Science, Bandar Abbas, Iran
3 Department of Anesthesiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Anesthesiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
|Date of Web Publication||7-Jan-2016|
Dr. Pooya Vatankhah
Department of Anesthesiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz
Source of Support: None, Conflict of Interest: None
Introduction: Lumbar facet joint pain accounts for 5-15% of the cases of chronic, axial low back pain. Most commonly, facetogenic pain is the result of repetitive stress and/or cumulative low level trauma, leading to inflammation and stretching of the joint capsule. Patients and Methods: In this descriptive study 76 patients who were diagnosed, after a diagnostic block, as having lumbar facet joint pain were evaluated by their age, sex, and body mass index (BMI). Data were collected according to a checklist and entered to SPSS version 16. Results: The mean age of the participants was 48.53 years; the participants included 44 women and 32 men. Lumbar facet joint pain was more frequent in the age range of 40-55 years. With respect to BMI, lumbar facet joint pain was most frequently seen in patients with BMI of 24.5-29.5 kg/m 2 (40.8%). Conclusion: Based on our findings, the chances of developing lumbar facet joint pain is more in women who are between 40 years and 55 years of age and whose BMI is 24.5-29.5 kg/m 2 .
Keywords: Age, body mass index (BMI), gender, lumbar facet joint, pain
|How to cite this article:|
Taheri A, Moallemy A, Dehghanian A, Vatankhah P. Evaluation of the relationship between age, gender, and body mass index, and lumbar facet joint pain. Indian J Pain 2016;30:19-22
|How to cite this URL:|
Taheri A, Moallemy A, Dehghanian A, Vatankhah P. Evaluation of the relationship between age, gender, and body mass index, and lumbar facet joint pain. Indian J Pain [serial online] 2016 [cited 2020 May 31];30:19-22. Available from: http://www.indianjpain.org/text.asp?2016/30/1/19/173454
| Introduction|| |
Pain emanating from the lumbar facet joints (zygapophysial joints) is a common cause of lower back pain in the adult population. Facet pain is defined as pain that arises from any structure that is part of the facet joints including the fibrous capsule, synovial membrane, hyaline cartilage, and bone.  The prevalence of persistent lower back pain due to the involvement of lumbosacral facet joints has been described in controlled studies as varying from 15% to 45% based on the type of population and study setting.  It has been repeatedly documented by radiological surveys as well as by postmortem studies that lumbar facet joints are frequently affected by osteoarthritis. ,,,, Since arthritis is a prominent cause of facetogenic pain, the prevalence rate increases with age. , There are no physical examination findings that are pathognomonic for diagnosis. The most frequent complaint is axial low back pain. It is widely acknowledged that lumbar paravertebral tenderness is indicative of facetogenic pain that is a claim supported by clinical trials.  Pain originating from the facet joints is predominantly presented in the lower back, buttocks, and thighs; however, it does not follow a reliable segmental pattern. ,,,, Even though radiation of the referred pain below the knee as far as the foot has been described,  the pain typically involves predominantly the proximal parts of the lower extremity. Pain distal to the knee is rarely associated with facet pathology. Pain from a lumbar zygapophysial joint can be relieved temporarily by anesthetizing the joint. Lumbosacral facet joints can be anesthetized either with intraarticular injections of a local anesthetic or by anesthetizing the medial branches of the dorsal rami that innervate the target joint. , Perhaps due to their safety, simplicity, and prognostic value, diagnostic medial branch blocks are performed more frequently than intraarticular injections. The strongest indicator for lumbar facet pain is pain reduction after anesthetic blocks of the rami mediales (medial branches) of the rami dorsales that innervate the facet joints. Diagnostic blocks are most frequently performed under radiographic guidance but can also be performed under ultrasound. ,
The joint may be considered to be the source of pain if the pain is relieved. The rationale for using lumbosacral facet joint blocks for diagnosis is based on the fact that lumbar facet joints have been shown to be capable of being a source of lower back pain and referred pain in the lower limb in normal volunteers.
| Patients and Methods|| |
We performed a cross-sectional study on 76 patients who were referred to pain clinics of Tehran University of Medical Sciences from March 2009 to February 2012. The patients were suspicious of having lumbar facet pain based on history and physical examination. Patients were suspicious of having lumbar facet pain based on history and physical examination. Diagnosis was confirmed and patients entered our study if after a diagnostic medial branch block, more than 50% pain reduction was observed. Patients with less than 50% pain reduction after the diagnostic block, anatomical disorders of the lumbosacral area, lower limb disabilities, or incomplete documents were excluded from the study.
Age, sex, height, and weight were measured for all patients and entered into a checklist. Body mass index (BMI) (weight in kilograms divided by the square of the height in meters) values were calculated and categorized using the World Health Organization cutoff points as follows: Normal BMI (19.5-24.4), grade 1 overweight (25-29.5), grade 2 overweight (30-39.9), and grade 3 overweight (>40).
All data were registered in SPSS version 16 (SPSS Inc., Chicago, IL). We performed the univariate analysis of new independent variables using Pearson's chi-squared test for qualitative variables, and the Mann-Whitney and Kruskal-Wallis tests for the quantitative variables. The bivariate relationship between each of the predictors (gender, age, and BMI) and the occurrence of lumbar facet pain was estimated with multinomial logistic regression analysis assuming a generalized logit link function. P values <0.05 were considered significant.
The study was performed in accordance with Good Clinical Practice guidelines and informed consent was taken from all the participants, as defined by the International Conference on Harmonisation (ICH) (http://www.ich.org).
The study was reviewed and approved by the institutional review board (IRB).
| Results|| |
From a total of 76 patients, 44 (57.9%) were females and 32 (42.1%) were males, with a mean age of 48.53 years (49.13 years in females and 47.71 years in males). There was no significant statistical difference between the mean age in the two genders (P value >0.05). Lumbar facet pain was more prevalent in females [Figure 1].
As noticed in [Table 1], lumbar facet pain was most frequently observed in patients in the age range of 40-55 years (40.8%). As shown in [Figure 2], lumbar facet pain was most frequent in grade 2 overweight patients (BMI of 24.5-29.5 kg/m 2).
| Discussion|| |
Lumbar facet pain is a common source of lower back pain. We studied age, gender, and BMI as three important risk factors of lumbar facet pain. In a study by DePalma, the most important cause of lower back pain in younger individuals (<35 years old), with 70-98% prevalence, was internal disc disruption.  Irwin et al. found that increased age was the only factor associated with the risk of developing sacroiliac joint pain.  Degenerative spinal changes are more prevalent with age.  Loss of disc height and increased load borne by the posterior elements are inherent in this process.  Given these biomechanical changes, facet joint pain is more prevalent in the elderly. We found that patients in the age range of 40-55 years had the greatest chance of developing lumbar facet pain. It seems that the lower age of pregnancy in Iran is the reason for the higher prevalence of lower back pain at a younger age compared to previous studies, as pregnancy is a strong predisposing factor. 
Another important risk factor for lumbar facet pain is gender. In our study, this disorder was more prevalent in women. Increased BMI in women increases lumbar lordosis  that consequently increases the load on facet joints in an upright posture, especially in a degenerated spine. ,, This finding also highlights the importance of preventive measurements and provides supplementary drugs in this gender.
BMI is another important factor among the causes of lower back pain. According to our findings, patients with BMI of 24.5-29.5 were more likely to develop lumbar facet pain. We also noticed that an increase in BMI beyond this scale can decrease the chances of developing lumbar facet pain. Previous investigations in this regard have been inconsistent, with some suggesting a positive relationship between increase in BMI and disc degeneration as evident by lumbar magnetic resonance imaging  and others indicating a lack of such association.  It seems that more studies including larger populations are needed to draw a definite correlation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cohen SP, Raja SN. Pathogenesis, diagnosis and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 2007;106:591-614.
Manchikanti L, Pampati V, Fellows B, Bakhit CE. Prevalence of lumbar facet joint pain in chronic low back pain. Pain Physician 1999;2:59-64.
Lewin T. Osteoarthritis in lumbar synovial joints. A morphologic study. Acta Orthop Scand Suppl 1964;(Suppl 73):1-112.
Shore LR. On osteo-arthritis in the dorsal intervertebral joints: A study in morbid anatomy. Br J Surg 1935;22:833-49.
Vernon-Roberts B, Pirie CJ. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil 1977;16:13-21.
Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis: Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966;25:1-24.
Magora A, Schwartz A. Relation between the low back pain syndrome and x-ray findings I. degenerative osteoarthritis. Scand J Rehab Med 1976;8:115-25.
Hicks GE, Morone N, Weiner DK. Degenerative lumbar disc and facet disease in older adults: Prevalence and clinical correlates. Spine (Phila Pa 1976) 2009;34:1301-6.
Manchikanti L, Manchikanti KN, Cash KA, Singh V, Giordano J. Age-related prevalence of facet-joint involvement in chronic neck and low back pain. Pain Physician 2008;11:67-75.
Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain 2007; 23:45-52.
Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain 1997;13:285-302.
Boswell MV, Singh V, Staats PS, Hirsch JA. Accuracy of precision diagnostic blocks in the diagnosis of chronic spinal pain of facet or zygapophysial joint origin. Pain Physician 2003;6:449-56.
McCall IW, Park WM, O′Brien JP. Induced pain referral from posterior lumbar elements in normal subjects. Spine (Phila Pa 1976) 1979;4:441-6.
Dreyfuss PH, Dreyer SJ; NASS. Lumbar zygapophysial (facet) joint injections. Spine J 2003;3(Suppl):50-9S.
Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N. Pain from the lumbar zygapophysial joints: A test of two models. J Spinal Disord 1994;7:331-6.
Mooney V, Robertson J. The facet syndrome. Clin Orthop Relat Res 1976;149-56.
Greher M, Kirchmair L, Enna B, Kovacs P, Gustorff B, Kapral S, et al
. Ultrasound-guided lumbar facet nerve block: Accuracy of a new technique confirmed by computed tomography. Anesthesiology 2004;101:1195-200.
Shim JK, Moon JC, Yoon KB, Kim WO, Yoon DM. Ultrasound-guided lumbar medial-branch block: A clinical study with fluoroscopy control. Reg Anesth Pain Med 2006;31:451-4.
DePalma MJ, Ketchum JM, Saullo TR. Multivariable analyses of the relationships between age, gender, and body mass index and the source of chronic low back pain. Pain Med 2012;13: 498-506.
Irwin RW, Watson T, Minick RP, Ambrosius WT. Age, body mass index, and gender differences in sacroiliac joint pathology. Am J Phys Med Rehabil 2007;86:37-44.
Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:403-8.
Pollintine P, Dolan P, Tobias JH, Adams MA. Intervertebral disc degeneration can lead to "stress-shielding" of the anterior vertebral body: A cause of osteoporotic vertebral fracture? Spine (Phila Pa 1976) 2004;29:774-82.
Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: A review. Pain Pract 2010;10:60-71.
Sowa G. Facet mediated pain. Dis Mon 2005;51:18-33.
Yang KH, King AI. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine (Phila Pa 1976) 1984;9:557-65.
Nachemson A. Lumbar intradiscal pressure: Experimental studies on post-mortem material. Acta Orthop Scand Suppl 1980;43:1-104.
Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am 2011;93:662-70.
[Figure 1], [Figure 2]