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 Table of Contents  
Year : 2016  |  Volume : 30  |  Issue : 1  |  Page : 19-22

Evaluation of the relationship between age, gender, and body mass index, and lumbar facet joint pain

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 Publication7-Jan-2016

Correspondence Address:
Dr. Pooya Vatankhah
Department of Anesthesiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-5333.173454

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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 2023 Mar 31];30:19-22. Available from: https://www.indianjpain.org/text.asp?2016/30/1/19/173454

  Introduction Top

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. [1] 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. [2] It has been repeatedly documented by radiological surveys as well as by postmortem studies that lumbar facet joints are frequently affected by osteoarthritis. [3],[4],[5],[6],[7] Since arthritis is a prominent cause of facetogenic pain, the prevalence rate increases with age. [8],[9] 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. [10] 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. [11],[12],[13],[14],[15] Even though radiation of the referred pain below the knee as far as the foot has been described, [16] 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. [11],[12] 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. [17],[18]

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 Top

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.

Author's responsibilities

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 Top

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].
Figure 1: Prevalence of lumbar facet joint pain in the two genders

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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).
Figure 2: Prevalence of lumbar facet joint pain according to BMI ranges

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Table 1: Prevalence of lumbar facet pain according to age range

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  Discussion Top

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. [19] Irwin et al. found that increased age was the only factor associated with the risk of developing sacroiliac joint pain. [20] Degenerative spinal changes are more prevalent with age. [21] Loss of disc height and increased load borne by the posterior elements are inherent in this process. [22] 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. [23]

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 [24] that consequently increases the load on facet joints in an upright posture, especially in a degenerated spine. [24],[25],[26] 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 [27] and others indicating a lack of such association. [19] 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 Top

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Vernon-Roberts B, Pirie CJ. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil 1977;16:13-21.  Back to cited text no. 5
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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.  Back to cited text no. 10
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  [Figure 1], [Figure 2]

  [Table 1]

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