Facet Joint Injections

Lumbar spine and neck pain have many causes. One of the most common causes stems from the facet joints in the spine. The facet joints are small
joints on both sides of the upper and lower parts of the vertebrae of the spine which act to provide stability to the spine.

Common Causes of Facet Joint Pain
1. Disc space narrowing - most common cause
2. Chronic inflammation
3. Mechanical stress
4. Bony facet joint abnormalities

Signs and Symptoms of Facet Joint Disease
1. Deep, dull aching pain in the low back can travel to the buttocks, hips, front or back of the thighs. In the case of neck pain, symptoms can travel to the back of the head and shoulders.
2. Often pain worsens when arching the back or neck backwards and turning side to side.
3. Often pain improves with flexing the back and neck forward.
4. There can be muscle spasm over the painful facet joint
5. Back pain usually improves when you are off your feet and worsens when you are on your feet.

Radiology Studies to Help Decide if you have Facet Joint Disease
X-rays, MRI scans, CT scans and bone scans can be helpful in pointing to the facet joints causing your pain. These studies can be normal in patients suffering from facet joint pain. Your Pain Management doctor can help determine if facet joints are the cause of your back or neck pain.

Treatment of Facet Joint Pain
1. Anti-inflammatory medications
2. Muscle relaxants
3. Physical therapy
4. Facet joint injections
When anti-inflammatory medications, muscle relaxants and physical therapy have not provided relief of your pain, injection of the painful facet joint with a local anesthetic and steroid medication may be necessary. This is done to determine which facet joints are causing your pain and provide relief of your pain.

Injection of the painful facet joint is done by having you lie on a special x-ray table. You will be given light intravenous sedation and local anesthesia at the site of the injection for your comfort. Using live x-ray (fluoroscopy) a needle will be guided into the facet joint. A long acting local anesthetic (to provide quick relief of your pain) and a steroid medication (to provide an anti-inflammatory effect on the facet joint surface) are then injected.

Receiving relief indicates the injected joints are likely the source of your pain. Frequently these injections can provide long-term pain relief. If the pain returns, the facet joints can be injected again. If there is temporary relief and no surgically correctable problem, the nerves which supply sensation to the facet joint can be interrupted. This is done by a procedure called radiofrequency facet nerve lesioning which uses radiofrequency energy.

What to Expect
You will hopefully have relief of your pain after your facet joint injections. You may have some muscle tightness and soreness at the injection site which may last for several days. Placing a cold pack over the injection site for fifteen minutes every two hours the first twelve hours may be helpful. Do not drive a motor vehicle for 24 hours after your procedure.

After 24 hours any muscle tightness would be treated with a heating pad or by directing water from a hot shower to the area of soreness. If this is not effective, medication can be prescribed for you. Food and liquid consumption can usually be resumed soon after the procedure. Please do not perform any vigorous activity for one week. When you are feeling better, slowly increase your activity and exercise.