09 Dec WHAT IS A FACET JOINT INJECTION?
The spine is a column of bones arranged one on top of the other. The bones are linked at the back by joints called facet joints, on each side. The facet stabilizes the spine, while also allowing movement. The facet joints may become painful either due to wear and tear (also called degenerative change) or injury and the inflammatory process may begin. The pain is felt around the facet joints and can spread. For lower back (lumbar) facet joints, the pattern of pain is usually an achiness in the low back, radiating across the lower back and slightly down the back of the buttocks and upper thighs. Usually, standing or bending backward worsens the pain. For neck (cervical) facet joints, the pattern of pain is an achiness in the neck, slight radiation across the neck and shoulders, and worsening symptoms with turning the head from side to side or looking up.
To treat the facet joints the pain physician uses facet joint injection. Under x-ray control, local anesthetic (to reduce pain in the short-term) and corticosteroid (to reduce pain and inflammation in the long-term) are injected into the targeted facet joints.
HOW LONG DOES THE PROCEDURE LAST?
The actual injection takes only a few minutes. However, the appointment will take about an hour due to the doctor’s consultation, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterward.
WILL IT HURT?
All of the procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. If you experience any pain during the procedure, your pain physician will inject more local anesthetic as needed.
You can choose to have IV sedation as well, which can keep you very comfortable. Sedation can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level, regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation.
WHAT WILL HAPPEN TO ME DURING THE TREATMENT?
Before the injection, your pain physician will discuss the procedure with you. Your doctor will either obtain your consent before the injection or confirm this consent if it was previously given. An x-ray machine (or other forms of image guidance) will be used to enable accurate injection. It is typically done with you lying on your stomach. Your blood pressure and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room. You will be carefully positioned and the skin around the injection site(s) will be cleaned with an antiseptic solution or spray. The pain physician will direct the injection(s) to the area(s) suspected to be a source of pain. When the injections are made, you may feel pressure, tightness or a pushing sensation. If there is any discomfort, do let the doctor know.
WHAT SHOULD I EXPECT AFTER THE PROCEDURE?
Shortly after the injection, you may notice that your pain may be gone or considerably less. This is due to the effect of the local anesthetic and lasts only for a few hours. Your pain may return and you may have some soreness at the injection site for a day or so. You should start noticing pain relief starting about 1-2 days after the procedure.
WHAT SHOULD I DO AFTER THE INJECTION?
You will usually be able to return home within a few hours after the injection and in some cases much sooner, depending on how long your doctor or nurse wants you to stay for recovery. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site.
CAN I GO BACK TO WORK THE SAME DAY OR THE NEXT DAY?
This will vary between individuals and may depend on the nature of your work. It is difficult to give general advice and so you should discuss this with your pain physician.
WHAT CAN I EXPECT IN THE DAYS AFTERWARD?
You may experience some soreness or ache at the injection site. the area of the injections must be kept dry for 24 hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular painkillers and medications as normal and this should settle down. In the weeks after the injections, as your pain decreases, you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone. It is best to increase your activities gradually. If you are unsure or finding exercises increasingly difficult, please contact your pain physician and discuss the possibility of physiotherapy.
WHAT ARE THE RISKS AND SIDE EFFECTS?
Overall, this procedure has very few risks. However, as with any procedure, side effects may occur. These are usually minor but there are risks with this procedure. Side effects may include mild local tenderness and/or bruising at the site of the injection, that usually settles over the first few days. The local anesthetic may rarely spread causing some numbness and/or weakness in your legs and other areas. Such an effect is very temporary. Though serious nerve injury may occur it is extremely rare (less than 1 in 10,000 cases). Rarely injection treatments may not relieve your pain.
WHO SHOULD NOT HAVE THIS INJECTION?
The decision on whether or not to go ahead with the injection is a shared decision between you and your pain physician. The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication, or if you have an active infection going on. With blood thinners, your pain physician may advise you to stop this for 4-7 days beforehand. Anti-platelet drugs may have to be stopped for 5-10 days prior to the procedure.