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 arthritis 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.
What To Expect
Once you have decided to have the facet injection, the following events take place:
- Do not eat or drink anything after midnight prior to your facet injection treatment.
- Discontinue all medications after midnight before your injection. If you are on routine medications for heart, blood pressure, or diabetes, you can take your medication, as usual, the morning of your injection with a sip of water. Diabetics may eat.
- Tell the doctor if you are on Coumadin (blood thinner) because special arrangements will need to be made. Current national spine procedure guidelines recommend stopping blood-thinning medications for between 2-7 days depending on the specific blood thinner you are taking. You may be required to seek permission from the prescriber of your blood thinner in order to discontinue the medication. Please discuss this with your doctor when considering and/or scheduling this injection.
- At the procedure center, you will change into a gown, provide medical history, medication list, allergy information, and sign consent forms. If you plan to receive IV sedation an IV will be placed.
- If you have a history of nausea or vomiting with prior surgical procedures please let the nursing staff or doctor know so that you may be pre-medicated with anti-nausea medication before the procedure.
- During the procedure, you will be lying on your stomach on a padded table in a procedure room.
- If IV sedation is used, monitoring equipment such as EKG pads and blood pressure cuff will be placed, along with nasal oxygen tubing.
- The area of injection will be washed with a cool room temperature liquid antiseptic cleaning solution.
- A local anesthetic will be used to numb the area of the injection.
- Fluoroscopy, a method used to make images with x-rays, will be used by the physician to accurately place the needle at the facet joint(s) being injected.
- A mixture of anesthetic and cortisone is injected into the facet joint(s)
- The injection procedure will typically take about 15-30 minutes
- After the procedure, you will be transported back to the recovery area
- You will be in a recovery room for about 30 minutes.
- It is important that you have someone to drive you home.
- It is common to experience an increase in pain once the numbing medicine wears off in 4-8 hours.
- The steroid in this back pain treatment does not become effective for 24-36 hours.
- Activity should be restricted for the first 4-5 days after the facet injection treatment.
- Discharge instructions will be provided in written form to take home after the procedure.
- A follow-up appointment with your doctor will occur usually within 1-3 weeks to discuss the results and re-evaluate your condition.
Frequently Asked Questions
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.
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 afterward is recommended overheat.
After the first couple of days, ice or heat can be used based on patient preference.
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.
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.
Fortunately, complications are very rare but may 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, an increase in blood sugar.
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.
Current guidelines recommend resuming blood thinning medication 24 hours after the procedure.