Facet Joint Injections
What is a facet injection?
Facet injections are injections of medications into the actual facet joints. Facet joints are located between each set of vertebrae in the spine from the neck to the tailbone. Facet joints allow each vertebra to move against the vertebra just above and just below it. Facet injections treat many different causes of neck and back pain. The injection includes both a long-lasting steroid and an anesthetic (bupivacaine). The steroid reduces the inflammation and irritation and the anesthetic works to numb the pain. Facet Injections and epidural steroid injections (ESI) are very similar in purpose but differ in the injection location.
How is the facet injection done?
For most facet joints, the procedure is done with you lying on your stomach on an xray table. Some cervical or neck area facet injections are done in other positions. The skin of the neck or back is cleaned with antiseptic solution. The skin is numbed with a small amount of local anesthetic (lidocaine). Once the numbing medication is given, there is little discomfort during the injection. Although sedation is usually not necessary, a small amount of sedation can be given for an anxious patient. and then the injections are carried out one joint at a time under direct xray guidance. The entire procedure usually takes 15 to 30 minutes.
How effective is the facet injection?
It is sometimes difficult to predict if the injection will help you or not. Facet injections can be surprisingly effective for those patients whose pain is truly coming from facet arthritis or inflammation, no matter how long the symptoms have been present. In one research study, a group of patients with back pain received facet injections and at 8 weeks of treatment 53% of people reported improvement of their pain and by 6 months of treatment over 68% reported the same (Anand 2007). The duration of pain relief varies from each individual but if the first facet injection provides relief then the procedure can be repeated several times a year. The most important success achieved with the use of facet injections is the rapid relief of symptoms that allows patients to become active again and resume their normal daily activities.
Another benefit to the use of facet injections is that it can be used as a diagnostic test to see 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,. It has been shown that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin. (Manchikanti 2007). However, if your pain is unresponsive then this gives your physician additional information that can help with diagnosing your condition.
Patients who respond well to these injections and who want a longer term solution may be candidates for radiofrequency ablation.
What are the risks?
Generally speaking, this procedure is safe. Uncommon side effects can occur, including pain at injection site, nerve damage, bleeding, infection, increase in pain, and a spinal headache following the injection. Other side effects are related to the administered steroid. These include elevated blood sugars, weight gain, water retention, stomach ulcers, suppression of body’s own natural production of cortisone and transient decrease in the immune system. You should speak with your physician about your particular risk assessment for the procedure.
Who should not have a facet injection?
Patients who have an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with the pain physician before receiving the procedure. There may be special instructions or lab testing or the procedure might need to be rescheduled.
What happens afterwards?
Immediately after the injection, your pain may be lessened, due to the local anesthetic’s numbing effect. When the local anesthetic wears off, your pain will return and you may have a sore back or neck for a day or two. All patients who have sedation will need a ride home. Patients not receiving sedation can usually drive themselves if they desire. We advise patients to take it easy for a day or so after the procedure. You may want to apply ice to the injection sites to keep it from getting sore the following day. Unless there are complications, you should be able to return to your work the next day. It may take up to a week for the steroid to begin working. If you don’t feel better within 10-14 days, see your doctor for more evaluation and to discuss different treatment.
Is facet injection right for you?
You may be a good candidate if you have arthritic facet joints on X-rays as well as chronic back or neck pain with movement. However, many patients with fairly normal looking facet joints on X-ray can still have arthritis or inflammation in the facet joints and may respond well to facet injections. Contact us for more information!
At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.
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
Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236