Understanding Your Options for Chronic Back and Neck Pain
Facet joint injections are minimally invasive procedures that deliver medication directly into the small joints along your spine to diagnose and treat chronic back or neck pain.
- What they are: Injections of local anesthetic and anti-inflammatory medication into the facet joints.
- Who they help: Individuals with chronic spine pain unresponsive to physical therapy or medication.
- How they work: The anesthetic numbs the joint to confirm it as the pain source, while a steroid reduces inflammation for lasting relief.
- Duration: Immediate relief lasts for hours; steroid relief can last for weeks to months.
- Procedure: A 15-30 minute outpatient procedure.
- Recovery: Most people return to normal activities within 1-2 days.
If you’re living with chronic back or neck pain, you’re not alone. Research shows that facet joint problems are responsible for up to 67% of neck pain cases and 45% of lower back pain cases. Many people struggle for years, but facet joint injections offer a targeted, non-surgical approach that can both identify the source of your pain and provide significant relief.
These injections serve a dual purpose. First, they act as a diagnostic tool. By temporarily numbing the facet joint, your doctor can confirm if it’s the true cause of your pain. Second, the included corticosteroid reduces inflammation, providing weeks or months of pain relief. This creates a valuable window to pursue physical therapy and regain function.
At California Pain Consultants, our double board-certified pain specialists, like Dr. Zach Cohen, have helped hundreds of patients find relief. Our approach combines advanced interventional procedures with personalized, comprehensive pain management to address the root cause of your pain.
What Are Facet Joint Injections and Who Do They Help?
Your spine is a tower of vertebrae, connected at the back by small, paired joints called facet joints (or zygapophyseal joints). Covered in smooth cartilage and filled with lubricating fluid, these joints allow you to bend and twist while keeping your spine stable. When these joints become inflamed or damaged from arthritis or injury—a condition called facet joint syndrome—the surrounding nerves send pain signals to your brain. You might feel a dull ache or sharp pain, especially when twisting or arching your back.
Facet joint injections deliver medication directly to the source of this pain. Each injection typically contains two key components:
- A local anesthetic to immediately block pain signals from the irritated nerves. If your pain drops significantly, it confirms the facet joint is the problem. This diagnostic function is extremely valuable.
- A corticosteroid, a powerful anti-inflammatory. While the anesthetic provides immediate but temporary relief, the steroid works over several days to reduce inflammation, offering relief that can last for weeks or months.
Scientific research on facet joint pain prevalence shows this is a common problem, accounting for pain in up to 67% of people with neck pain, 48% with upper back pain, and 45% with lower back pain.
Conditions Treated with Facet Joint Injections
These injections are effective for pain originating from the facet joints, often caused by:
- Spinal Osteoarthritis (Spondylosis): This is the most common cause, where cartilage wears down over time, leading to bone-on-bone friction, inflammation, and bone spurs.
- Wear and Tear: Years of use can lead to degeneration and chronic pain.
- Injuries: Trauma from car accidents, falls, or whiplash can damage the joint capsule or cartilage.
- Joint Instability: Weakened supporting structures can allow excessive movement, irritating the joint and surrounding nerves.
A key indicator of facet joint pain is discomfort that worsens when you twist your spine or lean backward, often felt as a dull ache in the lower back or neck that may radiate to the buttocks or thighs.
Who is a Good Candidate?
You may be a good candidate for facet joint injections if:
- You have experienced chronic back or neck pain for at least three months.
- Conservative treatments like physical therapy and anti-inflammatory medications (NSAIDs) have not provided adequate relief.
- Your pain worsens when you arch your back, twist, or bend sideways.
- Other causes, such as a herniated disc, have been ruled out through examination and imaging.
At California Pain Consultants, our board-certified doctors in San Diego, La Mesa, and Chula Vista will perform a thorough evaluation to determine if facet joint injections are the right next step for you.
The Facet Joint Injection Procedure: A Step-by-Step Guide
A facet joint injection is a routine, minimally invasive outpatient procedure that typically takes less than 30 minutes. Our team will guide you through every step to ensure your comfort and safety.
Preparation for Your Injection
Proper preparation is key to a smooth procedure.
- Consultation: We will review your medical history, allergies, and current medications. A physical exam and review of any imaging (X-rays, MRI) will help us confirm the source of your pain.
- Medication Adjustments: If you take blood thinners (e.g., aspirin, warfarin), we will provide specific instructions on when to stop them, typically 2-7 days before the procedure. Always consult the prescribing doctor before stopping any medication.
- Arrange a Driver: You cannot drive yourself home after the procedure. Please arrange for a friend or family member to drive you, or your appointment will be rescheduled.
- Fasting: You will likely be asked to avoid food and drink after midnight the night before. We will provide specific instructions for essential medications and managing conditions like diabetes.
During the Injection: What to Expect
Here is what happens during the procedure:
- Positioning: You will lie on your stomach on a procedure table. A pillow may be placed under your abdomen to help position your spine.
- Monitoring: Our staff will monitor your heart rate, blood pressure, and oxygen levels throughout the procedure.
- Sterilization: The injection site will be thoroughly cleaned with an antiseptic solution and covered with sterile drapes to prevent infection.
- Numbing: We will inject a local anesthetic into the skin, which causes a brief sting followed by numbness. This makes the rest of the procedure much more comfortable.
- X-ray Guidance (Fluoroscopy): We use real-time X-ray imaging to guide the needle with absolute precision to the target facet joint. This is critical for safety and effectiveness.
- Confirming Placement: A small amount of contrast dye is injected to confirm the needle is correctly positioned within the joint capsule on the X-ray.
- Medication Delivery: Once placement is confirmed, the therapeutic mixture of local anesthetic and corticosteroid is slowly injected into the joint. You may feel pressure, but it should not be painful.
Recovery and Aftercare for Facet Joint Injections
Your recovery is straightforward, but following instructions is important.
- Observation: You will rest in our recovery area for 20-60 minutes before going home.
- Temporary Effects: Numbness or weakness in the area or limb is normal and will wear off within a few hours.
- Pain Diary: We recommend keeping a simple log of your pain levels for the next few days. This helps us evaluate the injection’s effectiveness.
- Activity Restrictions: For the first 24-48 hours, you must:
- No driving for the rest of the day.
- No strenuous activity or heavy lifting.
- No heat on the injection site. Use ice packs for 15 minutes at a time for any soreness.
- No soaking in baths, pools, or hot tubs to prevent infection. Showers are usually fine.
- Return to Activity: Most patients can resume normal activities the next day. Listen to your body and gradually increase your activity level as your pain improves.
The immediate relief is from the anesthetic. The steroid’s anti-inflammatory effects begin to work within a few days, providing longer-lasting relief.
Effectiveness, Risks, and Alternative Treatments
Facet joint injections offer a powerful dual benefit: they provide diagnostic clarity by confirming the pain source and deliver therapeutic relief by reducing inflammation. This targeted approach is often the key to breaking the cycle of chronic pain.
How Effective Are the Injections and How Long Do They Last?
Relief typically occurs in two phases:
- Immediate Relief: The local anesthetic provides significant, but temporary, pain reduction within minutes, lasting for several hours. This immediate response is a positive diagnostic sign that we’ve targeted the correct joint.
- Longer-Lasting Relief: The corticosteroid begins to reduce inflammation over 2 to 7 days. This can provide meaningful pain relief that lasts from several weeks to many months.
The duration of relief varies per individual. Evidence on therapeutic effectiveness is mixed, with relief lasting anywhere from two to six months or more, depending on the severity of the arthritis and other factors. If successful, injections can be repeated, but we generally limit them to three per year to avoid cumulative steroid effects. These injections are a tool for pain management, not a cure for the underlying condition.
Potential Risks and Side Effects
While facet joint injections are very safe, all medical procedures have risks. Most side effects are mild and temporary:
- Soreness or bruising at the injection site.
- A temporary flare-up of your usual pain for 2-3 days.
- Facial flushing, mild swelling, or temporary weight gain.
- A temporary increase in blood sugar for patients with diabetes.
Serious complications are rare but include infection, bleeding, allergic reaction, or nerve damage. The use of fluoroscopy (X-ray guidance) dramatically minimizes these risks.
Call us immediately if you experience:
- Fever over 100.5°F or chills
- Severe, persistent headache
- Increased redness, warmth, or discharge at the injection site
- New or worsening numbness or weakness in your arms or legs
- Loss of bladder or bowel control
Alternative and Complementary Therapies
Injections work best as part of a comprehensive treatment plan. At California Pain Consultants, we combine them with other therapies to maximize your results.
- Physical Therapy: This is the most important complement. Pain relief from the injection creates a window of opportunity to strengthen core muscles, improve flexibility, and correct posture, leading to more durable improvement.
- Medications: Anti-inflammatory drugs (NSAIDs) can help manage pain between injections.
- Lifestyle Modifications: Maintaining a healthy weight, using ergonomic furniture, and practicing stress reduction can all reduce strain on your spine.
- Radiofrequency Ablation (RFA): If injections provide temporary relief, RFA may be the next step. This procedure uses heat to disable the small nerves that transmit pain signals from the facet joint, providing relief that can last for a year or more.
- Medial Branch Blocks: These are purely diagnostic injections that numb the nerves supplying the facet joint. A successful block is a strong predictor that RFA will be effective for you.
We create a personalized plan for each patient. For more details, visit our interventional pain management services page.
Frequently Asked Questions about Facet Joint Injections
Here are answers to some of the most common questions we receive about facet joint injections.
How do facet joint injections differ from epidurals?
While both are spinal injections, they target different structures to treat different types of pain. The table below clarifies the key differences.
| Feature | Facet Joint Injections | Epidural Steroid Injections (ESI) | Medial Branch Blocks |
|---|---|---|---|
| Target Location | Directly into the facet joints (small joints at the back of the vertebrae) | Into the epidural space (the area surrounding the spinal cord and nerve roots) | Near the medial branch nerves (small nerves that innervate the facet joints) |
| Conditions Treated | Pain originating from inflamed or arthritic facet joints (e.g., facet joint syndrome) | Radicular pain (nerve root pain) such as sciatica, herniated disc pain, spinal stenosis, radiculopathy | Pain originating from facet joints (primarily diagnostic, can be therapeutic) |
| Primary Purpose | Diagnostic (confirm facet joint pain) and Therapeutic (reduce inflammation and pain) | Primarily Therapeutic (reduce inflammation and pain around compressed nerve roots) | Primarily Diagnostic (identify if facet joint is the pain source), can be therapeutic |
| Medication | Local anesthetic + corticosteroid | Local anesthetic + corticosteroid | Local anesthetic (for diagnostic); Local anesthetic + corticosteroid (for therapeutic) |
In short, facet injections and medial branch blocks address joint-based pain, while epidurals treat pain originating from compressed nerve roots.
Are facet joint injections painful?
We prioritize your comfort. You will feel a brief pinch and sting from the local anesthetic used to numb the area. During the main injection, most patients feel only a sensation of pressure, not sharp pain. It is common to have some mild soreness at the injection site for a day or two, which can be managed with ice. Overall, the procedure is very well-tolerated.
How much do the injections cost and are they typically covered by insurance or Medicare?
Cost and coverage are important considerations. The total cost depends on your geographic location, the type of facility (hospital vs. surgery center), and the number of spinal levels treated.
- Insurance Coverage: Most private insurance plans and Medicare cover facet joint injections when they are deemed medically necessary. This typically requires documentation of chronic pain (at least 3 months) that has not responded to conservative treatments like physical therapy and medication.
- Prior Authorization: Insurers almost always require prior authorization before approving the procedure. Our team at California Pain Consultants is experienced in navigating this process and will work with your provider on your behalf.
We recommend contacting your insurance provider to understand your specific benefits and potential out-of-pocket costs. Our staff is also available to assist with billing and insurance questions.
Take the Next Step Towards Pain Relief
Living with chronic back or neck pain can be isolating and exhausting, affecting every aspect of your life. At California Pain Consultants, we understand this struggle and are dedicated to helping you find a path forward.
Facet joint injections represent hope backed by medical evidence. They offer both answers and relief, helping us pinpoint the source of your pain and creating a window for healing. The targeted pain relief allows you to engage in physical therapy, build strength, and reclaim the activities you love.
What sets California Pain Consultants apart is our commitment to you as a whole person. Our board-certified doctors serving San Diego, La Mesa, Chula Vista, and surrounding communities create comprehensive, personalized treatment plans. We don’t just perform an injection; we partner with you for the long haul, adjusting your care as your needs evolve.
Your pain is real, and it deserves a real solution. If you’ve been struggling with chronic back or neck pain, it’s time to explore your options. Facet joint injections could be the key to open uping your path to a life with less pain.
Ready to take the next step? Learn more about our advanced interventional pain management services and how we can help you. Visit our website or contact us today.