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Facet joint injections


Expert reviewer, Dr Dudley Bush, Consultant in Anaesthesia and Pain Management
Next review due August 2018

Facet joint injections can help to diagnose and sometimes to treat neck and back pain that originates in your facet joints. Each of the vertebrae in your spine has a set of facet joints, which stabilise your back and allow your spine to move.

If you’re considering having a facet joint injection, it's important to make a decision that’s right for you. This information is designed to help you decide whether you should have a facet joint injection or not.

An image showing the different parts of the spine

What are facet joint injections?

Facet joint injections usually contain two types of medicine – a local anaesthetic (which numbs the pain) and steroids (which help to reduce swelling and inflammation). There are two ways in which your doctor may inject you.

  • Your doctor may inject a local anaesthetic and steroid directly into your joint to relieve pain. This is called a facet joint injection.
  • Your doctor may inject a local anaesthetic over the nerves in your facet joint. These nerves transmit pain signals to your brain if you have inflammation in your facet joint. This is called a medial branch block and will temporarily stop the pain signals being carried by the nerve from a specific facet joint.

Why would I have a facet joint injection?

Facet joint injections can confirm if your pain is coming from your facet joints and if you need further treatment such as radiofrequency denervation. It can also sometimes help to treat neck or back pain caused by inflammation of your facet joints. This can happen if the joints worn down by conditions such as osteoarthritis.

Your doctor will usually suggest you try other treatments before offering you a facet joint injection. These alternatives may include exercise and painkillers, for example.

It isn't known for sure how well facet joint injections work, as there haven’t been many good quality studies and results have been inconsistent. However, there's some research to suggest they may help to manage pain that starts in the facet joints and affects your:

  • neck (cervical region)
  • upper back (thoracic region)
  • lower back (lumbar region)

You will usually have facet joint injections as part of a wider treatment plan that includes other therapies such as exercises and rehabilitation. It’s important to realise that a facet joint injection will only temporarily relieve your pain and it doesn’t work for everyone. However, if it does 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.

Facet joint injections aren't a suitable treatment for everybody. For example, if you have a bleeding disorder or certain allergies, you probably shouldn't have one. If your back is sore or stiff but your doctor can't find a cause for the pain, they won't offer you a facet joint injection. It's unlikely to help. Ask your doctor if a facet joint injection is an option for you.

What happens during a facet joint injection?

You will usually have a facet joint injection in hospital. 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.

Your doctor may give you 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 may need to take X-rays, CT or ultrasound scans to help them guide the needle to the right spot. They may need to inject a type of dye called contrast media to help highlight where the needle needs to go.

You will need to lie on your tummy or your side while you have the procedure. There are two ways in which you may have the injection.

  • If you're having a facet joint injection, your doctor will inject a local anaesthetic and steroid directly into your joint to relieve pain.
  • If you're having a medial branch block, your doctor may inject an anaesthetic over the nerves in your facet joint. This will temporarily stop the pain signals being carried by the nerve from a specific facet joint.

It will only take a few minutes to give you the facet joint injection but it may take longer to have the X-rays.

Aftercare

After you have had a facet joint injection, you will need to stay sitting or lying down for about 20 minutes. Your back and neck may feel numb at first because of the local anaesthetic, but this will go away. Don't drive yourself home – ask your family or a friend to go with you to hospital.

Facet joint injections don't work for everyone and even if does work, 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 this for a time before you have the procedure too.

Pros and cons

This information is intended to help you understand the advantages and disadvantages of facet joint injections. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that's right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

Pros

  • A facet joint injection can help your doctor to find the cause of your neck or back pain.
  • A facet joint injection 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 helps to reduce your pain, you may find it easier to do physiotherapy or other rehabilitation. This may help to improve your condition in the long term.

Cons

  • You might not get any pain relief from facet joint injections.
  • Any pain relief you get from a facet joint injection is likely to last only between three months and a year. It isn't a cure for your pain.
  • If you have a bleeding disorder, or have certain types of allergies your doctor may not offer you a facet joint injection.
  • There are possible risks and complications linked to facet joint injections, which include headaches, bleeding, an infection, and an allergic reaction. Although you're unlikely to get any of these, it’s important to be aware of them when deciding whether or not to have the injection.

Making your choice about facet joint injections

Different things are important to different people. Have a think about how important each of the issues above is to you in making your decision whether to have facet joint injection or not. Next, together with your doctor, do the following.

  • Review the list of pros and cons.
  • Rank each of the pros and cons from zero to five, with five being the most important to you.
  • Add up the total value for the pros and cons – the highest total value should indicate what’s important to you.

Your doctor can give you advice and help you choose the right treatment for 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 else can I do to help relieve my pain?
  • Should I try other treatments first before having a facet joint injection?
  • What should 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?


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Related information

    • Spinal injections. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published December 2013
    • Lumbar facet arthropathy. Medscape. www.emedicine.medscape.com, published 11 February 2015
    • Paraspinal injections – facet joint and nerve root blocks. Medscape. www.emedicine.medscape.com, published 21 October 2014
    • 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. www.britishpainsociety.org, published March 2014
    • Low back pain and sciatica. Medscape. www.emedicine.medscape.com, published 22 December 2014
    • Map of Medicine and the British Pain Society. Low Back and Radicular Pain. International View. London: Map of Medicine; November 2012
    • Commissioning guide: low back pain: broad principles of the patient pathway. British Orthopaedic Association. www.boa.ac.uk, published November 2013
    • Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Care Excellence (NICE), May 2009. www.nice.org.uk
    • Falco FJ, Manchikanti L, Datta S, et al. An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician 2012; 15(6):E909–53. www.painphysicianjournal.com
    • Adult acute and subacute low back pain. Institute for Clinical Systems Improvement. www.icsi.org, published November 2012
    • Nerve blocks. Radiological Society of North America. www.radiologyinfo.org, published 7 March 2013
    • Epidurals and back pain. Back Care. www.backcare.org.uk, published March 2010
    • Pain and pain relief. PatientPlus. www.patient.info/patientplus, reviewed 16 January 2015

  • Reviewed by Rachael Mayfield-Blake, Bupa Health Content Team, August 2015
    Expert reviewer, Dr Dudley Bush, Consultant in Anaesthesia and Pain Management
    Next review due August 2018



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