Facet Injections

Back and neck pain are costly and painful conditions that affect billions of people worldwide. An estimated 90% of people will experience back and neck pain at some point in their lives. While many of these pain conditions respond well to conservative measures, like exercise and physical therapy, some people will need more help. Facet injections are a minimally invasive way to find relief from stubborn pain conditions that have not responded to other treatments. Here’s what you should know about this treatment approach.

What are facet injections?

Facet injections are a minimally invasive, non-surgical treatment that can help with many different causes of neck and back pain.

The facet joints connect and stabilize each of your vertebra to the one below and above it. Delicate nerves responsible for movement and sensation twine in and around these facet joints. When injury or another condition causes inflammation in the joint, however, swelling can compress those nerves and cause pain.

A facet injection can help.

This injection includes both a long-lasting steroid and an anesthetic such as lidocaine or bupivacain. The steroid reduces inflammation and irritation in the area, while the anesthetic works to numb the pain. The combination medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation.

How can a facet injection help me?

Back and neck pain is a common complaint across the globe, and facet injections are one way to tackle persistent inflammation and pain.

The conditions that most commonly benefit from facet injections include:

Facet injections bring about rapid pain relief for most patients. This allows patients to experience enough relief to become active again. With this, patients regain the ability to resume their normal daily activities, including rehabilitation and physical therapy to treat the underlying cause of their pain.

Another benefit to facet joint injections is that they can be used as a diagnostic test to determine if the pain is actually coming from the facet joints. If your pain disappears with the injection, then it is clear that the pain is originating from the joint. However, if your pain is unresponsive, this gives your doctor information that can help them in diagnosing what’s causing pain.

Facet injection benefits

There is plenty of evidence that supports the use of facet injections for a variety of pain conditions.

A study in 2019 found that facet injections resulted in a dramatic decrease in pain at one, two and three months, especially for patients with facet joint osteoarthritis.

As a diagnostic tool, facet injections can help identify patients who are good candidates for radiofrequency ablation (RFA). This procedure is often recommended for younger patients who are managing chronic back pain conditions. Other studies also confirm that facet injections are an excellent treatment choice before RFA or another more invasive procedure.

How does the facet injection procedure work?

Facet joint injections are an outpatient procedure that usually takes less than 15 minutes. Your full appointment may only take an hour.

IV sedation is usually not necessary but talk to your doctor if you are feeling anxious about the procedure. They may be able to offer you a mild sedative to take beforehand.

You will position yourself face down on an examination table, and the skin above the targeted joint will be cleaned and sterilized. To make the procedure more comfortable, your doctor will numb the area.

Using fluoroscopic guidance, your doctor will guide a small needle into the correct place. They inject a small amount of contrast dye to confirm that the needle is placed correctly. Once they have that confirmation, your doctor injects the medication.

Risks

With a minimal amount of risks, facet injections are considered an appropriate non-surgical treatment for many patients. Most of the risks occur with improper placement of the needle. Misplacing the needle, such as advancing it too deeply or positioning it incorrectly, can potentially cause nerve damage, bleeding, infection, and a headache following the injection. Work with a doctor who has performed many of these procedures, and also uses fluoroscopic guidance, to help reduce your risk.

The other risks of the facet joint pain treatment relate to the actual medication given. Some of the potential side effects of the corticosteroid may include:

Elevated blood sugar
Weight gain
Stomach ulcers
Transient decrease in the immune system

The risk of developing these side effects are much higher in a person taking oral corticosteroids. Before receiving a facet injection, talk to your doctor about any concerns or personal risk factors you might have.

Recovery

After your procedure, you will rest in a recovery area briefly. You may notice immediate relief of pain, but it can take a few days to feel the full effects of the injection.

Have a friend or family member drive you home from your appointment and take the day to rest. Avoid strenuous activity for at least the first 48 hours after your procedure. Check in with your doctor to see when you can resume prior activity levels.

If you experience minor soreness at the injection site, apply ice in a 15-minutes-on, 15-minutes-off schedule. Limit pain medications, either prescription or over-the-counter, to give the facet injection time to work.

If you do not experience any pain relief, it’s possible that the facet joint was not the source of your pain. Call your doctor if you experience an increase in your pain level, swelling or redness at the injection site, or fever, as these could be signs of infection.

References

Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777
Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396
Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236
Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025