What is a Facet Joint Injection?

Facet joint injections involve administering anti-inflammatory medications and/or steroids into the facet joints, which connect the vertebrae in the spine. Inflammation in the facet joints can occur due to various acute or chronic conditions. When the lower back’s facet joints become inflamed, pain is typically felt in the lower back, spreading towards the buttocks and thighs, especially when standing or bending forward. Inflammation in the neck facet joints often causes pain around the neck area that may radiate through the neck and shoulders, intensifying when turning the head or looking upward.

Why are Injections Given?

There are two main reasons for facet joint injections:

Diagnostic: If local anesthetics relieve pain, it can indicate that the facet joints are the pain source. A second procedure may confirm the diagnosis and lead to further nerve root treatment with radiofrequency therapy.

Therapeutic: Steroids may reduce inflammation and nerve root sensitivity, providing long-term pain relief, which can last from several weeks to several months.

How Long Does the Procedure Take?

The injection itself only takes a few minutes, but more time is usually set aside for discussions with the pain specialist, filling out necessary forms, and post-procedure monitoring.

What Medications Are Administered?

The injection typically includes a mixture of local anesthetics and steroids.

Will It Hurt?

The procedure can be performed under local anesthesia with a very thin needle. Patients feel a mild pinch followed by slight warming as the anesthetic takes effect, numbing the area. After numbing, the procedure may involve minor pressure where medications are injected. Additional anesthetics may be administered if needed.

Will I Be Asleep During the Procedure?

This depends on your preference. The procedure can be done under local anesthesia or intravenous sedation, allowing the patient to feel relaxed and comfortable.

Patients must prepare in advance for sedation. Do not eat or drink for 6 hours prior to the procedure. Ensure you have someone to accompany you, as you will not be able to drive or perform complex tasks for 24 hours after sedation. If you are taking any medications, inform your doctor beforehand. If you have undergone sedation, its effects may persist for up to 24 hours. During this time, you should not drive, consume alcohol, operate machinery, or travel without an accompanying person.

What Should I Inform My Doctor About Before the Procedure?

Discuss your medications with your pain doctor, and inform them if you are pregnant, diabetic, allergic to iodine, Betadine, local anesthetics, or steroids, or have a cold or infectious disease.

How Is the Procedure Performed?

Usually performed with the patient lying on their stomach, the doctor and assistant monitor blood pressure and breathing throughout. The injection is performed under ultrasound guidance after antiseptic cleaning of the injection site. Local anesthetic is applied, and then, under ultrasound guidance, anti-inflammatory and anesthetic drugs are injected into the facet joint.

What to Expect After the Injection?

After the injection, pain relief may last for a few hours due to the local anesthetic. Pain may return with mild soreness at the injection site for one to several days. Pain relief usually occurs within 1-2 days post-procedure.

What Should I Do After the Procedure?

After being observed by the medical team for 20-60 minutes, you can go home.

Jei jums buvo atlikta sedacija, galite jausti jos poveikį iki 24 valandų. Per ateinančią parą neturėtumėte vairuoti, vartoti alkoholio, valdyti mechaninius prietaisus, keliauti be lydinčio asmens.

Avoid strenuous activities for a few days.

Use cold compresses on the injection site if advised.

When Can I Return to Work?

You may return to work immediately or the next day unless there were complications. Consult with your doctor for specific guidance.

How Long Will the Effects Last?

The duration of pain relief varies; initial relief from the anesthetic may be immediate but brief, lasting only a few hours, while steroids may provide relief for weeks to months.

How Many Injections Might I Need?

This depends on the individual case and should be discussed with your doctor.

Can I have more than one injection?

If the first injection is successful but the pain returns after some time, you may be scheduled for an additional procedure. It is important to discuss with your pain specialist how long you experienced pain relief after the first injection and what the doctor recommends in your specific case.

How will I know if the procedure will help me?

It is difficult to predict whether facet joint injections will be effective in your case. Generally, this procedure is highly effective for patients who experience the symptoms described above. However, since there are multiple potential sources of pain in the spine, individual responses to pain treatment can vary.

Risks and Side Effects

The procedure is generally low-risk. However, as with any invasive procedure , there are potential risks and side effects that the patient must be informed about.

The most common side effect is intensified pain after the injection (usually temporary). Rare side effects include accidental puncture of the spinal fluid sac (which can cause headaches), infection, bleeding, nerve damage, or a lack of pain relief.

Side effects from injected steroids may include temporary weight gain, short-term increases in blood sugar levels (typically affecting individuals with diabetes), and temporary water retention. Discuss more about steroid medications with your pain specialist. Some individuals may experience temporary redness, sweating, and/or a rapid heartbeat for a few days.

Contact your pain specialist if you have any concerns after the procedure or if you notice swelling or bleeding at the injection site.

Who should avoid facet joint injections?

You should not undergo the procedure if you are allergic to any of the medications used, if you are taking blood thinners, or if you have an active infection at the time of the procedure. If you are taking blood thinners, your pain specialist may advise you to switch to alternative medications 4–7 days before the procedure. Antithrombotic medications may need to be paused 5–10 days prior to the procedure. Any changes, adjustments, or pauses in medication should only be determined by your pain specialist during a consultation.