Facet joint pain arises from degenerative changes within the facet joint. These changes may cause inflammation. The mainstay of treatment is anti-inflammatory medication, physical therapy, chiropractic care and activity modification. If these treatments fail to provide adequate pain relief, injections may be considered.
Facet injections may also be used as a diagnostic evaluation. If the pain decreases significantly after the injection, this helps to verify the joint as a pain generator. This can be helpful in planning future treatment. These injections can provide relief from pain for days or even years or, in some cases, permanently.
Facet injections are primarily used to manage facet joint pain (or facet syndrome) which is a type of arthitis located along the spine (osteoarthritis.) The deterioration of the facet joints in the spine can cause several types of pain.
Facet joint degeneration happens when the cartilage between the two joints is gone and bone begins to rub against bone. Serious pain can manifest in the neck, upper back or lower back. Depending on where the arthritis is, it may be harder for the sufferer to move their neck, back or hips – meaning walking, sitting or looking around can be much more difficult.
Treatments for facet joint osteoarthritis can help reduce the pain and keep it at a manageable level.
Once you have decided to have the facet injection, the following events take place:
1) How long does the injection last? Frankly, the results are quite variable for everyone. Duration of relief is anywhere from days to weeks or months. The numbing agent will last for several hours and then wear off. The steroid typically becomes effective in 48-72 hours after the procedure and will last in the body for up to 1 week. However, the therapeutic effect of the medication can persist much longer in many patients.
2) What should I expect when I get home after the procedure? During the immediate hours after the procedure, your spine in the area of injection can feel a little weak or odd because of the numbing effect of the injection. Additionally, some soreness from the needle injections sites is expected and can last a few days. Icing the area for 20 minutes at a time, as needed, for the first couple of days afterwards is recommended over heat. After the first couple of days, ice or heat can be used based on patient preference.
3) When can I resume activity? Refrain from any strenuous activity on the day of the procedure, however, bed rest is not required. If you have received IV sedation, you cannot drive on the day of the procedure. Normal physical activity, such as walking, work, and basic household chores can resume the day after the procedure with a gradual increase in more intense physical activity in the week following the procedure, as tolerated.
4) When can I resume my usual medication? You may resume your usual medication regimen after the procedure except for blood thinners. It is recommended that blood thinner be restarted 24 hours after your injection.
5) What are the possible complications? Fortunately, complications are very rare but do include bleeding, infection, nerve or spinal cord injury, increased neck or back pain, or allergic reaction to medications used. In addition to complications, patients can also experience certain effects related to the medications injected, most likely the steroid. Steroid medication can cause temporary symptoms such as flushing of the face or skin (‘hot flashes’), fluid retention, temporary weight gain, increased appetite, irritability or anxiousness, and, if diabetic, increase in blood sugar.
6) I am on a blood thinner. What should I do? Tell your doctor and the procedure scheduling staff. Based on your specific blood thinner, you will be provided with instructions regarding when to stop taking your blood thinner medication. You may be required to obtain a permission slip from the doctor that prescribes your blood thinner before discontinuing the medication. On occasion, if you have special medical conditions, such as a mechanical heart valve, it may be required that you take a blood thinner shot leading up to the procedure to replace the discontinued blood thinner pill. If blood thinner shots are required, additional guidance will be provided.
7) When can I resume my blood thinner? Current guidelines recommend resuming blood thinning medication 24 hours after the procedure.