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Facet-mediated low back pain — FRCA Final MCQ

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HardPain MedicineFacet-mediated low back painFRCA Final

A 45-year-old man has chronic low back pain without radiculopathy. MRI shows degenerative facet arthropathy, diagnostic medial branch blocks gave two separate episodes of 80% pain relief, and physiotherapy has improved function but pain limits work. What is the most appropriate pain management?

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Correct answer: D — Offer lumbar medial branch radiofrequency denervation

Facet-mediated pain supported by positive diagnostic medial branch blocks is an appropriate setting for radiofrequency denervation. Epidural steroid injection is more suited to radicular pain than isolated facet pain. Long-term strong opioids should not be the default for chronic primary back pain. Ongoing exercise and functional restoration remain important after intervention.

Reference: NICE NG59 low back pain and sciatica; Faculty of Pain Medicine Core Standards