Home MedizinCurrent trends in rheumatology: from the past to the present
Current trends in rheumatology: from the past to the present

Current trends in rheumatology: from the past to the present

Low back pain is an extremely common health problem, and almost every adult has experienced it at least once to some extent.

However, suffering from chronic low back pain may last for many years. The most common causes of chronic pain are intervertebral disc injuries and changes in intervertebral joints. These problems often cause the primary muscle spasms that cause chronic pain.

Unfortunately, today, neither medications nor non-pharmacological methods of treatment are a panacea for patients with acute and chronic back pain. Further, acomplete recovery for such patients is rarely observed. However, specialists have not given up and continue to try to find a way to cope with this issue. Research in this direction has been going on for decades.

For example, intra-articular injections into the facet joints have gradually become one of the most important therapeutic means for treating back pain. Recent studies have shown that up to 52% of patients experience lower back pain caused by lumbar facet joint syndrome. The facet joint is where the articular processes of the vertebrae meet. They are in almost constant motion along with the spine and quite often simply wear out or undergo degeneration in many patients. When the articular cartilage becomes thin or disappears, the bone tissue reacts with excessive growth, resulting in osteophytes and enlarged joints. In such cases, arthritis (osteoarthritis) is thought to develop, which can cause significant back pain when moving. Such facet joint arthritis is called facet joint syndrome.


Rheumatology was formed over centuries of advances in clinical and experimental medicine. Moreover, and undoubtedly, the further development of scientific understandings  of the regularities of the emergence and course of pathological processes underlying rheumatological diseases will occur as new factual data are accumulated and comprehended—this is the main condition for the progress of rheumatology and the formation of the theory of medicine.

Overestimating the results of one’s work and giving them undeservedly increased importance are often quite sincere and can be explained simply by the author’s unfamiliarity with the historical aspect of the problem: the less familiar one is with the past research, the more surprising present results seems to him, and especially so when made by himself/herself. Therefore, only thorough knowledge of the history of the discipline in general and of the problem in particular makes it possible to clearly and accurately identify that (even if very small but really fundamentally new) which can be called a contribution to science and a step forward in scientific progress.

One of the studies taking the direction of solving the above mentioned rheumatology problem took place from January 1980 to December 1984.  Four hundred and fifty-four (454) patients recieved injections into their facet joints. Prior to the injections, all of the patients had complaints of low back pain, normal neurological examination findings, and no signs of radicular tension. Three hundred and ninety (390) completed the protocol, which included assessments of the lumbar’s range of motion and pain before and after facet injection.

A total of 127 variables were examined in the study. There were 229 men and 161 women, with an average age of 38 years. Arthrograms of the facet joints were performed before the intra-articular injection of local anesthetic and cortisone. Immediately after the injection, the greatest pain relief was observed during extension and rotation in the lumbar spine. However, patients with more pain in lumbar extension and rotation in general did not note further pain relief. From this study, researchers could not identify clinical syndromes of facet joints or predict whether patients responded better to this procedure. In addition, the facet joints were not usually the only or primary source of low back pain in the vast majority of the patients studied.

The three scientists who conducted this work – Jackson R.P., Jacobs R.R., Montesano P.X. – were awarded the 1988 Volvo Award in Clinical Sciences („Facet joint injection in low-back pain. A prospective statistical study“). Scientists refer to the results of their study in their scientific papers and dissertations to this day.

Dr. Pascule X. Montesano is the principal Orthoapedic Spine surgeon at Montesano Spine & Sport in Palm Beach Gardens, Florida. After receiving a Bachelor of Science degree from Siena College and then attending medical school at New York Medical College in Valhalla, NY, Dr. Montesano completed extensive postgraduate training and has worked towards achieving a variety of certifications and awards. In 1989, Dr. Montesano received the Howmedica Spinal Fixator Grant. In addition to his years of training and experience in surgical and non-surgical treatments of spine disorders, Dr. Montesano has completed an extensive spine fellowship program. He is a diplomate of the American Board of Spine Surgery Society, the American Academy of Orthopaedic Surgeons and The American College of Forensic Examiners.

Dr. Robert R. Jacobs is a physician. He graduated from the University of Arkansas for Medical Sciences (UAMS) College of Medicine and the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine. He received his MD from the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine and has been a practitioner for more than 20 years.

Dr. Robert P. Jackson is an  alternative medicine wellness doctor specializing in the effects of environmental toxins and nutritional depletion on health. He has been in private practice since 1975. Education: Lehigh University (1966 -1977), Logan University (1972) in Anatomy, Physiology, Pathology, Chiropractic Theory and Practice.

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