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Facet joint injections and medial branch blocks


Expert reviewer, Dr Norman Kufakwaro, Consultant in Pain Medicine and Neuromodulation, Bupa Cromwell Hospital
Next review due August 2021

Facet joint injections and medial branch blocks can help to determine whether or not your neck and back pain originates from your facet joints. Your facet joints are small pairs of joints that link the bones in your spine together. If the injections help to relieve your pain, it shows that your facet joints are the source of the pain. You may then be able to have a longer-term treatment called radiofrequency denervation. This helps to relieve your pain for a longer period of time.

Not everyone who has a facet joint injection or medial branch block finds it helpful. If you’ve been offered one, it's important to understand what's involved so you can make a decision that’s right for you.

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What are facet joint injections and medial branch blocks?

Facet joint injections and medial branch blocks usually contain two types of medicine – a local anaesthetic (which numbs the pain) and a steroid (which helps to reduce swelling and inflammation). Facet joint injections and medial branch blocks work in the same way, but are given in different parts of the joint.

  • In a facet joint injection, your doctor will inject the local anaesthetic and steroid directly into your joint. This is to reduce inflammation in your joint space.
  • In a medial branch block, your doctor will inject the local anaesthetic and steroid over the nerves in your facet joint, which transmit pain signals to your brain. This will temporarily stop the pain signals being carried by the nerve.

Why would I have a facet joint injection or medial branch block?

Your doctor may suggest a facet joint injection or medial branch block if you have neck or back pain, and your doctor thinks it could be coming from your facet joints. The injection can help to determine the source of your pain and give you some temporary pain relief if the source is your facet joints. You can get facet joint pain with conditions such as osteoarthritis, which can cause your facet joints to become worn down and inflamed.

If you find that facet joint injections or medial branch blocks are helping to relieve your pain, your doctor may suggest longer-term treatment with radiofrequency denervation.

Your doctor will suggest you try other treatments before offering you a facet joint injection or medial branch block. These may include painkillers, exercise and psychological therapy. If you do try facet joint injections or medial branch blocks, you'll usually continue with these other therapies as part of a wider treatment plan.

Facet joint injections and medial branch blocks aren't a suitable treatment for everybody. For example, if you have a bleeding disorder or certain allergies, you may not be able to have one. Your doctor will tell you if a facet joint injection or medial branch block is an option for you.

What happens during a facet joint injection or medial branch block?

You'll need to go into hospital to have a facet joint injection or medial branch block. You can have the injection and go home the same day – you won't need to stay overnight. A specialist doctor will give you the injection.

You’ll need to lie on your front while you have the procedure. Your doctor will clean your skin, and inject a local anaesthetic to numb any pain while you're having it done. They may offer you sedation too, to help you relax.

Your doctor will guide a needle to the affected area of your back or neck, using X-ray images or sometimes CT scans to help them find the right spot. They may need to inject a type of dye called contrast media to help highlight where the needle needs to go.

Once the needle is in place, your doctor will inject the local anaesthetic and steroid directly into your joint, or in the case of medial branch block, around the nerves in your facet joint.

It will only take a few minutes to give you the injection but it may take up to half an hour including the X-ray images.

What to expect afterwards

You'll be taken to a recovery room after the procedure, where you'll be monitored for a short time before you're able to leave. You may have your blood pressure or pulse checked, and you'll be asked whether you're experiencing any side-effects. You may feel numb, or have some weakness in your back, neck or legs at first and need some support to stand up.

You can usually go home between one and three hours after the procedure. You'll need somebody to drive you home – you won't be able to drive yourself. Ideally, you should have someone stay with you for your first night at home after your procedure.

How well do facet joint injections and medial branch blocks work for pain relief?

It's important to realise that not everyone will get pain relief with facet joint injections and medial branch blocks. Studies looking at how well facet joint injections and medial branch blocks work for back or neck pain have had mixed results. Much of the research that has been done isn't of very good quality, so it's hard to say for certain.

Some people do seem to benefit from the procedure. It's hard to predict whether or not facet joint injections or medial branch blocks will work for you. Even when you do get pain relief, it can take several days for you to feel the effect. It's a good idea to keep a pain diary as this can help your doctor to see whether or not the injection has worked for you. Your doctor might ask you to keep a pain diary for some time before you have the procedure.

Facet joint injections and medial branch blocks will only provide temporary pain relief. You may be able to have more injections when the effects wear off. If the injections do help to relieve your pain, it may allow you to do physiotherapy or other rehabilitation. This may then improve your symptoms in the long term. If you've had a positive response to a facet joint injection or medial branch block, your doctor may offer you treatment with radiofrequency denervation. This can relieve your pain for a longer period of time.

What are the side-effects of facet joint injections and medial branch blocks?

The main side-effect associated with facet joint injections and medial branch blocks is discomfort in the area where you have the injection. This usually gets better on its own very quickly.

More serious complications from facet joint injections and medial branch blocks are fortunately uncommon and usually only temporary, but it's important to be aware of them. Possible complications include infection, bleeding, and injury to a nerve. If you develop a headache or fever, or have ongoing weakness or numbness after you've gone home, contact the unit where you had the procedure.

Some people develop side-effects from the steroid medicine that's used. These might include flushing of your face, having a greater appetite than normal, feeling sick or having diarrhoea.

Deciding on a facet joint injection or medial branch block

Your doctor will go through all your treatment options with you, including what to expect from facet joint injections and medial branch blocks. You'll need to give your consent if you do choose to have the procedure.

A good way to help decide whether to have any procedure is to weigh up the pros and cons (benefits and risks). Here is a summary of the pros and cons for facet joint injections and medial branch blocks.

Pros

  • A facet joint injection or medial branch block can help your doctor to find the cause of your neck or back pain. This means they may be able to offer you certain treatments that are more likely to help you.
  • A facet joint injection or medial branch block may reduce the pain in your neck or back. This can improve your quality of life and make it easier to get about and carry on with your normal daily activities.
  • If the facet joint injection or medial branch block helps to reduce your pain, you may find it easier to do physiotherapy or take part in an exercise programme. This may help to improve your condition in the long term.
  • There are relatively few side-effects and complications associated with facet joint injections and medial branch blocks. These are generally mild and resolve on their own.

Cons

  • You might not get any pain relief from facet joint injections or medial branch blocks.
  • Any pain relief you do get from a facet joint injection or medial branch block is likely to last for only a few months. It isn't a cure for your pain.
  • Although rare, it is possible to have a more serious complication from a facet joint injection or medial branch block. This could include an infection or an allergic reaction to one of the medicines in the injection.

Have a think about how much you value each of the issues above when making your decision whether to have treatment or not. Different people will put different values on each of these, so how you view them is very individual to you.

Questions to ask your doctor

Have a think about any questions you would like to ask your doctor before you decide whether to have a facet joint injection or not. Here are some example questions you might like to ask.

  • What other treatment options do I have to relieve my pain?
  • What can I expect to happen after I’ve had a facet joint injection?
  • Will I be able to exercise after the injection? Are there any types of exercise it's best not to do?
  • Should I have physiotherapy or some other rehabilitation after having my injection?
  • How can I tell if my injection has worked? How long will it take until I know if it's worked?
  • What is the likelihood of the procedure working? How long will the effects last?
  • How will you reduce the risk of complications?


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Related information

    • Paraspinal injections – facet joint and nerve root blocks. Medscape. emedicine.medscape.com, updated 21 October 2014
    • Discogenic low back pain. BMJ Best Practice. bestpractice.bmj.com, last updated December 2017
    • Lumbar facet arthropathy. Medscape. emedicine.medscape.com, updated 5 February 2017
    • Spinal injections. OrthoInfo – American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed December 2013
    • Lumbar facet joint injection. British Association of Spine Surgeons, March 2016. www.spinesurgeons.ac.uk
    • Low back pain and sciatica in over 16s: assessment and management. National Institute for Health and Care Excellence (NICE), 30 November 2016. www.nice.org.uk
    • Musculoskeletal lower back pain. BMJ Best Practice. bestpractice.bmj.com, last reviewed January 2018
    • Standards of good practice for medial branch block injections and radiofrequency denervation for low back pain. British Pain Society and Faculty of Pain Medicine of the Royal College of Anaesthetists. March 2014. www.britishpainsociety.org
    • Staal JB, de Bie R, de Vet HCW, et al. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. doi:10.1002/14651858.CD001824.pub3

  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2018
    Expert reviewer, Dr Norman Kufakwaro, Consultant in Pain Medicine and Neuromodulation, Bupa Cromwell Hospital
    Next review due August 2021



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