Pain Management Procedures
Facet Joint Injections
Facet Joint Injections - Cervical, Thoracic, and Lumbar
What is a facet joint injection?
Facet joints are small paired joints along the back of the spine. They guide movement and can become painful from arthritis, injury, or inflammation. A facet joint injection places medication directly inside one of these joints. It is different from a medial branch block, which targets the small nerve outside the joint.
When may it be recommended?
The procedure may be considered when pain is thought to come from a specific facet joint in the neck, mid-back, or low back. Typical symptoms are more often aching and localized than electric or shooting. Pain may worsen with extension, twisting, or prolonged standing. Examination and imaging help narrow the possibilities, but neither one alone proves that a facet joint is the pain source.
What happens during the procedure?
You lie on an imaging table. After the skin is cleaned and numbed, fluoroscopy or another imaging method guides a small needle into the joint. Contrast dye may be used to confirm position, followed by local anesthetic and sometimes a corticosteroid. Several joints may be treated when clinically appropriate.
What should I expect afterward?
The numbing medicine may provide immediate but temporary relief. A steroid, when used, may take several days to work. Improvement varies, and the injection may be more useful for short-term symptom control than for lasting relief. Physical therapy or a home exercise program may be easier to perform while pain is reduced.
Important risks and limitations
Possible effects include soreness, bruising, temporary pain flare, facial flushing, or a short-term rise in blood sugar. Less common risks include infection, bleeding, allergic reaction, nerve injury, or unintended spread of medication. A facet joint injection generally is not the diagnostic test insurers use to qualify a patient for medial branch RFA; that usually requires a separate medial branch block.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.