by Nicole Berardoni M.D, Tory McJunkin M.D, and Paul Lynch M.D.
Facet injections are a minimally-invasive non-surgical treatment that is used as treatment for many different causes of neck and back pain. It works by reducing the inflammation and irritation in the facet joints of the spine that is causing you pain.
The syndromes most commonly requiring facet joint pain treatment include:
The facet joint of the spine is a moveable connection that connects one vertebra (bone of the spine) to another. This injection includes both a long-lasting steroid and an anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation and irritation, and the anesthetic works to numb the pain. The combination medicine then spreads to other levels and portions of the spine, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes
The facet injections and the epidural steroid injections (ESI) are very similar but differ in the location that they inject the medicine. In an ESI, the medication is injected into the epidural space, whereas in the facet injection, it is injected directly into the joint.
Benefits of Facet Injections
Another benefit to facet joint injections is that it can be used as a diagnostic test to see if the pain is actually coming from the facet joints. If your pain disappears with the injection, then it is clear that the pain is originating from the joint. It has been shown that therapeutic lumbar facet joint nerve blocks with local anesthetic, with or without steroids, may be effective in the treatment of chronic low back pain of facet joint origin (Manchikanti 2007). However, if your pain is unresponsive, then this gives your physician information that can help her in diagnosing your condition.
A large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques was developed by the American Society of Interventional Pain Physicians and provides recommendations to clinicians and patients in the United States. In regard to the facet injections, they state that the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain (Boswell 2007).
Risks of Facet InjectionsWith a minimal amount of risks, facet injections are considered an appropriate non-surgical treatment for many patients who suffer from back pain. The associated risks with this procedure involve misplacement of the needle, either advancing the needle too deeply, or positioning it incorrectly. The outcome of the incorrect positioning of the needle can potentially cause nerve damage, bleeding, infection, and a headache following the injection.
As with any medication taken, there are always risks and potential side effects that may occur. The other risks of the facet joint pain treatment may be directly caused by the actual medication given; however, the risk of developing these side effects are much higher in a person taking oral corticosteroids. Some of the potential side effects of the corticosteroid may include elevated blood sugar, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system. Before receiving a facet injection, all patients should be assessed by their physician about risk assessment for the procedure.
OutcomesLumbosacral injections for facet joint pain treatment have increased dramatically in the Medicare population from 1994 to 2001 and are becoming even more popular today (Friedly 2007). They are being used more frequently because they have provided very successful results in the treatment of back pain.
In a research study, a group of patients with back pain received facet injections, and at eight weeks of treatment 53% of people reported improvement of their pain. By six months of treatment, over 68% reported the same (Anand 2007). The duration of pain relief varies from each individual, but if the first facet injection provides relief then the procedure can be repeated up to three times a year.
- Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777
- Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396
- Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236
- Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025