effective pain treatment

What are facet injections?

Facet injections are injections of medications into the actual facet joints performed by a pain doctor. Facet joints are located between each set of vertebrae in the spine from the neck to the tailbone. Facet joints allow each vertebra to move against the vertebra just above and just below it. There are many other technical names for facet joints.

What is the purpose of facet injections?

Facet injections are used to reduce the inflammation and swelling of tissue in and around the facet joint space. This may in turn reduce pain and other symptoms caused by inflammation or irritation of the facet joint and surrounding structures. Usually we think of facet joint pain as primarily spine pain, though in some patients there can also be referred pain into the surrounding tissues and even into arms or legs.

Am I a candidate for facet injections?

Patients with arthritic or thickened facet joints on X-rays that also have any chronic back or neck pain with movement are usually good candidates for facet injections. However, many patients with fairly normal looking facet joints on X-ray can still have arthritis or inflammation in the facet joints and may respond well to facet injections. Bending or twisting often aggravates facet joint pain in the neck or back. Certain postures tend to improve the symptoms while others aggravate the symptoms, according to pain management doctors. Some patients have facet joints injured in whiplash injuries or other traumatic injuries to the neck or back. Most patients receiving facet injections have already tried other, more conservative, treatments including anti-inflammatory medication, chiropractic or physical therapy.

How long do the facet injections take?

The actual injections take only about 10 to 20 minutes and are performed by a skilled pain doctor.

What is actually injected?

The injection consists of a mixture of local anesthetic and a steroid medication.

Will the facet injections hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint. Some patients prefer to have intravenous sedation that can make the procedure easier to tolerate.

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. Some patients also receive intravenous sedation, which can make the procedure easier to tolerate. The amount of sedation given generally depends upon each patient’s tolerance. Some patients receive enough sedation that they may have amnesia and not remember part or all of the actual facet injections.

How are the facet injections performed?

For most facet joints, the procedure is done with the patient lying on the stomach. Some cervical or neck area facet injections are done in other positions. All facet injections are done under x-ray guidance. Patients receiving intravenous sedation are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin of the neck or the back is cleaned with antiseptic solution and then the injections are carried out one joint at a time. Typically, only one side of the neck or back is done at any visit. Usually no more than three or perhaps four joints are injected at any visit.

What should I expect after the facet injections?

Immediately after the injection, you may feel that your pain may be gone or lessened. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a sore back or neck for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself.

What should I do after the facet injections?

All patients who have sedation will need a ride home. Patients not receiving sedation can usually drive themselves if they desire. We advise patients to take it easy for a day or so after the procedure. You may want to apply ice to the injection sites to keep it from getting sore the following day. Otherwise, you should be able to perform the activities that you could do before the facet injections and possibly more. We do not advise that you test the limits right away, but rather build up over time.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness or aching at the injection sites.

How long does the effect of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid medication starts working in about 2 to 7 days and its effect can last for several days to a few months.

How many facet injections do I need to have?

For any particular facet joint, you may ever only actually need one injection. Facet injections are often thought of as diagnostic injections, used to confirm that a particular facet joint or group of joints is the actual cause of the neck or back pain. Once this confirmation is made by a pain management doctor, most patients will go on to have a facet rhizotomy, during which a small nerve branch that goes to the individual facet joint is electrically heated or burned to decrease sensation in the facet joint for a much longer period of time that most regular facet injections last. Of course, to get all of the involved facet joints may take several visits. Likewise, some patients who get a very long response from simple facet injections may choose to have them repeated rather than go on to a facet rhizotomy, although that is the exception, not the rule.

Can I have more than three or four facet injections at once?

We generally do not perform more than three, or occasionally four, injections at one time. This is because of a number of reasons. Some patients get quite sore afterward, even if the actual injections seem to go okay. Some patients, even with a wide area of neck or back pain, often do just as well with a few of the worst or most tender joints injected as they would do if we injected a lot of facet joints. Perhaps even more important, but somewhat bizarre, some insurers will only pay for three facet injections on any given date of service.

Will facet injections help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who have recent onset of pain may respond much better than the ones with long standing pain. However, facet injections can be surprisingly effective for those patients whose pain is truly coming from facet arthritis or inflammation, no matter how long the symptoms have been present.

What are the risks and side effects of facet injections?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain; which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, Epidural block etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have facet injections?

If you are allergic to any of the medications to be injected, if you have an active infection going on, or you are poorly controlled diabetes or heart disease, you should not have the injection or at least consider postponing it if postponing would improve your overall medical condition.

Adapted from: http://www.medcentral.org/body.cfm?id=346 July 25th, 2010