If you struggle with persistent neck or back pain, you may have come across the facet joint injections procedure as a potential solution. This article serves as a complete introduction to facet joint injections, explaining what they are, how facet injections work, why doctors use them, and what to expect during the procedure Facet joint injections offer a minimally invasive approach to pain relief by targeting the small joints of the spine. This procedure often results in months of reduced pain for many patients and is associated with a low risk of complications. Keep reading to learn how this procedure is performed, its benefits and risks, and whether it might be the right option for managing your pain.
What is a Facet Joint Injection?
A facet joint injection is a medical procedure in which a doctor injects pain-relieving and anti-inflammatory medication directly into one of the facet joints of the spine. Facet joints are the small bony joints located at the back of each vertebra, where one vertebra connects to another, providing stability and guiding motion. Over time, wear and tear, arthritis, or injuries can irritate these joints, leading to inflammation and pain in the neck or back. By delivering medication right into the affected joint, a facet injection can help reduce this inflammation and block pain signals, thereby relieving pain at its source.
Facet joint injections are considered a minimally invasive procedure. They are typically done in an outpatient setting, meaning you remain awake and go home the same day and the entire process usually takes less than 30 minutes. During the injection, imaging guidance such as fluoroscopy (a live X-ray) or CT scan is used to ensure the needle is precisely placed in the correct facet joint. The injected solution often includes a combination of a local anesthetic (for immediate pain relief) and a corticosteroid (to reduce inflammation for longer-term relief). The local anesthetic numbs the nerves around the joint, which can bring almost instant relief, while the steroid medicine works more slowly to calm inflammation that contributes to ongoing pain.
Importantly, a facet joint injection does not cure whatever underlying condition is causing the joint pain (such as arthritis). Instead, it is a therapeutic measure to manage pain and improve function. Relief from a successful injection can last from several weeks to a few months, allowing you a window of reduced pain. Because it targets the problem joint directly, this procedure can be more effective for facet pain than oral pain medications, which affect the whole body. It can also be repeated a few times per year if needed (commonly up to three times) to help maintain pain relief.
What are facet joint injections used for?
Facet joint injections serve both diagnostic and therapeutic purposes, helping to identify and alleviate pain originating from the facet joints. In terms of treatment, the primary goal is to alleviate chronic neck or back pain that originates in the facet joints, a condition sometimes broadly called facet joint syndrome or facet osteoarthritis. Doctors may recommend a facet injection if you have moderate to severe spine pain that has not improved with conservative measures like physical therapy, medications, rest, or lifestyle changes over at least a few months. In fact, facet joint injections are often considered after about 3 months of persistent pain that hasn’t responded to non-invasive treatments. Common causes of facet joint pain include osteoarthritis, spinal degeneration, joint instability, or trauma that leads to inflammation of the joint capsule. By reducing inflammation in the joint, the injection can provide relief from these conditions. For example, if arthritis in the facet joints is causing stiffness and pain, the steroid in the injection can ease swelling and the anesthetic can block pain, allowing improved mobility.
Facet joint injections are also a valuable diagnostic tool. Because multiple structures in the spine can cause similar symptoms, it’s not always easy to pinpoint the exact source of back pain. A facet injection can help confirm whether a particular facet joint is the culprit. If you experience immediate pain relief from the numbing medicine in the injection, it strongly suggests that the targeted facet joint was causing your pain. (On the other hand, if you feel no relief right after the injection, that facet joint is likely not the primary source of pain.) In this way, facet injections guide doctors in planning further treatment. A positive but short-lived response might indicate that longer-term solutions, like a radiofrequency ablation to disable the tiny nerves around the facet joint could be effective next steps once it’s confirmed the facet joint is involved.
It’s worth noting how common facet-related pain is. Research estimates that facet joint problems account for up to 45% of chronic lower back pain, about 48% of mid-back pain, and as many as 67% of neck pain cases. Given how frequently facet joints are at fault, being able to accurately diagnose facet pain (and treat it at the same time) is very useful. In summary, doctors use facet joint injections to reduce pain and inflammation in the spine’s facet joints, to help patients resume normal activities with less discomfort, and to confirm the pain source when other tests are inconclusive.
If you live in Texas and suffer from persistent back or neck pain, especially from arthritis or injury, it is best to consult with a specialist to see if a facet joint injection could be beneficial for you. Our specialty orthopedic care clinics, along with the most experienced doctors throughout Texas, can help you make a full recovery.
Benefits of Facet Joint Injections
Facet joint injections play an important role in spine care and pain management. Below are some key benefits and reasons why this procedure is often considered:
Targeted Pain Relief
Unlike oral painkillers or general treatments, a facet injection delivers medication directly to the specific joint that is causing pain. This targeted approach can provide significant relief in that exact area of the neck or back without as many systemic side effects. Patients often report a noticeable decrease in pain within minutes to hours due to the local anesthetic, which can be a huge relief if they have been in pain for a long time. Reducing pain at the source can also help restore mobility. for instance, easing a stiff neck or allowing you to bend your lower back without sharp pain.
Minimally Invasive Alternative
Facet injections are a nonsurgical treatment. For people with persistent facet joint pain, these injections may help by delaying or even eliminating the need for more invasive treatments like spine surgery. It is performed with just a needle rather than an incision, which means no stitches, minimal recovery time, and you can go home the same day. The procedure typically takes only about 15–30 minutes, plus a short monitoring period. There’s no general anesthesia required (you stay awake), and sedation, if used at all, is very light. This makes facet injections a relatively convenient option for pain relief.
Dual Diagnostic and Therapeutic Value
As mentioned, a facet injection can confirm if the facet joint is truly the source of pain while simultaneously treating it. This dual purpose is a major benefit. If the injection significantly reduces your pain, it not only gives you relief but also validates that the facet joint was the problem. With that knowledge, your healthcare provider can plan longer-term strategies. If the injection provides only short-term relief, doctors might follow up with a procedure like radiofrequency ablation for more sustained pain control. If it provides no relief, they know to look for other pain sources. In other words, either outcome of the injection (relief or no change) yields useful information for guiding your care.
Improved Function and Quality of Life
By easing pain, facet injections can help you return to normal daily activities that pain was hindering. For example, someone with facet arthritis in the lower back might find it hard to stand or walk for long periods. After a successful injection, they may be able to move around with much less discomfort. The injection can also facilitate physical therapy and exercise. Often, doctors use injections as part of a comprehensive rehabilitation plan – the immediate pain relief can “unlock” your ability to participate in strengthening and stretching exercises that address the underlying issues. In many cases, the main goal of facet joint injections is to reduce pain sufficiently to allow patients to return to daily activities and participate in physical therapy, ultimately supporting better spine health.
High Success Rate in Selected Patients
For the right candidates, facet joint injections can be highly effective. If imaging (like an MRI) shows clear arthritis or inflammation in the facet joints corresponding to where you feel pain, and your pain is primarily in the facet area (for example, low back pain that doesn’t radiate down the leg), the success rates are quite encouraging. studies and clinical experience indicate pain relief success rates upwards of 80% in well-chosen cases. Many patients get substantial relief lasting for weeks or months, allowing them a much better quality of life during that period. It’s important to note that results vary. those with very severe facet joint degeneration or other complicating spine issues might not get as much relief. However, even partial relief can be beneficial when pain is chronic and severe.
Effectiveness and success rates
A common question is how long the pain relief from a facet joint injection lasts and how we measure its success. Generally, the pain reduction from the local anesthetic in the injection will be felt immediately but wears off after a few hours once that medicine metabolizes. The corticosteroid component, if included, usually kicks in within a couple of days and can provide longer relief – often several weeks or a few months of reduced pain as it calms down inflammation in the joint. On average, patients who respond well might enjoy relief for about 2 to 4 months, though some may experience longer and some shorter durations. Pain relief tends to be temporary (since the wear-and-tear arthritis or injury causing the pain may still be present), but these injections can be repeated periodically. Doctors typically limit facet injections to around three times per year to avoid excessive steroid use and diminishing returns.
Effectiveness can be quite high in diagnosing and relieving facet pain, especially in the short term. In fact, as noted above, when patients are properly selected (i.e. their symptoms and imaging strongly suggest facet joint issues), most will experience significant relief. One hospital’s data indicates that in ideal candidates, facet injections relieved pain effectively in 80% or more of cases. However, it’s also true that facet injections are not a permanent fix. The underlying degenerative changes in the joint remain, so pain may gradually return as the steroid’s effect wears off. If a facet joint injection provides only very brief relief or none at all, doctors will re-evaluate the diagnosis. In cases where facet injections do help but the pain comes back, a longer-lasting procedure like radiofrequency ablation (burning the tiny nerve fibers that carry pain from the joint) might be the next step.
It’s also worth mentioning that facet joint injections are generally considered safe and repeatable, which contributes to their utility. While surgery on the spine is a one-time major event with a long recovery, an injection can be done multiple times over the years if needed and has minimal recovery downtime. Additionally, these injections are often covered by insurance (including Medicare) when medically indicated, since they are an established treatment for chronic spinal pain. This makes them an accessible pain management option for many patients. In short, facet injections are an effective intervention that can break the cycle of pain for a period of time, giving you a chance to restore function and pursue other therapies to strengthen your back or neck.
If you are looking for the most trusted and professional orthopedic specialists and Facet injections services in Texas, our experts at GTOA offer these services in Arlington, Houston, San Antonio, Dallas, Corpus Christi and Beaumont, ensuring effective pain relief and management in Texas for patients like you. Take the next step towards a more comfortable life by consulting with our orthopedic and pain management specialists about your options.
Facet Joint Injections Procedure: Step-by-Step Guide
If you and your doctor decide to proceed with a facet joint injection, it’s helpful to know what exactly will happen on the day of the procedure. Here’s a step-by-step overview of what typically happens during a facet joint injection procedure:
Step 1: Preparation and Positioning
On the day of the injection, you will be asked to lie down on a procedure table, usually face-down for a low back (lumbar) injection. (For a neck injection, sometimes face-down or on your side is used, depending on what’s easiest for the doctor to access the facet joints.) The medical team will connect you to monitors for your heart rate, blood pressure, and oxygen, this is standard for safety, even though the procedure is minor. If you are particularly anxious, you may be given a small dose of a sedative or relaxing medication through an IV line to help you stay calm. However, in most cases full sedation is avoided, because the doctor may want you to be awake enough to report pain relief during the procedure. (If sedation is used, you’ll need someone else to drive you home afterwards.) The entire injection process is fairly quick, typically about 15–30 minutes from start to finish, plus some time afterwards for observation.
Step 2: Sterilization and Numbing
Once you’re positioned comfortably, the doctor will identify the target area on your spine (using prior imaging scans as a guide) and cleanse the skin over that area with an antiseptic solution. This sterile preparation helps prevent infection. Next comes a small injection of local anesthetic to numb the skin and tissues over the facet joint. You’ll feel a quick pinch or sting when the numbing medicine is injected, similar to a typical shot and a brief burning sensation as it spreads, but this step is over quickly. The local anesthetic will make the procedure itself much more comfortable by desensitizing the area. After a minute or two, the skin and deeper tissues become numb. (Thanks to this numbing, most patients report that the facet injection procedure is not very painful, you might feel pressure, but not sharp pain.) The doctor may also place a sterile drape over your back to keep the area clean during the injection.
Step 3: Needle Insertion with Imaging Guidance
With the area numb, the doctor will advance a specialized thin needle through the skin toward the facet joint that is suspected of causing pain. This is done under live imaging guidance, usually fluoroscopy (X-ray) or sometimes ultrasound or CT – to ensure precise placement of the needle tip into the facet joint space. You won’t feel the needle cutting through skin much, thanks to the anesthetic, though you might sense some pressure or pushing as the doctor navigates it into position. The doctor is very careful during this process, using the imaging to avoid contacting nerves or other sensitive structures. Once the needle is properly positioned, a small quantity of contrast dye may be injected. This dye shows up on the X-ray and confirms that the needle is indeed inside the joint and that fluid is not flowing into unintended areas (like a blood vessel). You probably won’t notice the dye being injected; it’s simply used to confirm correct needle placement. Once confirmed, the stage is set to deliver the medication.
Step 4: Injection of Medication
With the needle perfectly positioned in the facet joint, the doctor slowly injects the prepared medication solution through the needle into the joint capsule. The injection usually contains a blend of a corticosteroid medication and a local anesthetic. The steroid (such as triamcinolone, betamethasone, or dexamethasone) is the anti-inflammatory component that will help calm swelling and irritation in the joint over the coming days. The anesthetic (such as lidocaine or bupivacaine) provides immediate numbing of the joint nerves for instant pain relief. The volume injected is small (usually only about 1 mL or so) to just fill the joint space without over-distending it. You might feel a little pressure as the fluid enters the joint, but still no sharp pain. Once the medication is delivered, the needle is carefully withdrawn. Afterwards, the physician will cover the injection site with a small bandage. No stitches are needed, as the needle puncture is very small and will heal on its own.
Step 5: Recovery and Post-Procedure Monitoring
Once the injection is finished, you’ll be taken to a recovery area where you’ll rest under observation for about 30 minutes to an hour. During this time, the medical staff will periodically check your vital signs and make sure you’re feeling okay as the immediate effects of the injection set in. One important part of this post-injection monitoring is assessing your pain relief. Because a local anesthetic was part of the injection, you may begin to feel relief from your usual pain within minutes. The doctor or nurse might ask you to move or do certain tasks that previously caused pain, to see if the injection has lessened your discomfort. For example, if twisting your lower back was painful before, they may have you carefully try that motion now to gauge any improvement. This serves as the diagnostic test portion of the procedure. if you feel significant immediate relief, it suggests the facet joint injection hit the right spot.
Assuming you feel well (most patients do), you’ll be discharged on the same day. Since sedation is usually not used heavily, many people can drive themselves home, but if you did receive a sedative or just feel a bit sore or lightheaded, you’ll need someone else to drive for safety. You’ll be given some aftercare instructions. Generally, you should take it easy for the rest of the day: avoid strenuous activities and follow any specific guidelines your doctor provides. You might be advised not to submerge in water (like a bath or pool) for a day or two to reduce infection risk at the injection site. It’s normal to have some soreness at the injection spot once the numbing medicine wears off later that day. an ice pack can help with this. The steroid typically needs a couple of days to start reducing inflammation, so your chronic pain might flare back up slightly before it improves. By around 48 hours, you should start noticing the longer-term relief kicking in as the steroid does its job. Your doctor might ask you to keep a pain diary or note how your pain changes in the days following the injection, which can be useful information for follow-up appointments.
Risks and Side Effects of Facet Joint Injections
Facet joint injections are generally very safe, especially when performed by experienced specialists under imaging guidance. Nonetheless, as with any medical procedure, there are some risks and potential side effects to be aware of. The comforting news is that serious complications are very uncommon. In fact, one large study of nearly 12,000 facet joint injections found only 8 cases of major complications, all of which were related to infection (such as deep infection in the joint), and only one of those patients had a severe outcome. Here we’ll break down the common side effects versus the rare risks:
Common, mild side effects:
Most people have little to no trouble after a facet injection. The most common issues are minor and short-lived. You might experience some localized pain or soreness at the injection site once the numbing medicine wears off. essentially, your back or neck might feel a bit tender or bruised for a day or two. There can also be some swelling at the site. In some cases, patients notice a temporary increase in their usual back or neck pain for a day, this can happen as the mechanical act of injecting fluid into the joint can irritate it briefly, or as the local anesthetic wears off before the steroid starts working. This flare in pain is usually mild and fades within a couple of days as the steroid reduces the inflammation. Applying an ice pack and taking it easy can help during this time. Your doctor may recommend or prescribe a mild pain reliever if necessary for that soreness. Another mild effect can be flushing or warmth in your face or body for a short period after the injection, which sometimes happens with steroid medications.
Steroid-related effects:
Because corticosteroids are a component of many facet injections, they can occasionally cause some transient side effects in the body. These may include fluid retention (feeling a bit puffy), increased appetite, temporary weight gain, mood swings or irritability, anxiety, or trouble sleeping for a night or two. Not everyone experiences these. in fact, at the small doses used for a single joint injection, systemic side effects are usually minimal. If they do occur, they typically resolve within a few days. Doctors use the lowest effective dose of steroid to minimize these possibilities. If you are diabetic, be aware that steroids can raise blood sugar levels for a short time, so extra monitoring of blood glucose may be advised for a day or two.
Uncommon risks:
Serious complications from facet joint injections are infrequent, particularly when the procedure is performed with appropriate safety measures. The riskiest complication is an infection. There’s a very small chance that bacteria could be introduced into the joint, potentially causing an infection like septic arthritis, or an infection in the surrounding soft tissues. To prevent this, the procedure is done under strict sterile conditions (sterilized skin, sterile equipment) and many doctors will have you wear a mask or take prophylactic antibiotics if you are at particular risk. Signs of an infection after the injection would include worsening pain, fever, or redness at the site, and you should contact your doctor immediately if those occur.
Other rare risks include bleeding (especially if you have a bleeding disorder or were not off blood thinners, you should always follow instructions to stop certain medications before the injection), or nerve injury. The spinal nerves run very close to the facet joints, so there is a slight risk the needle could irritate a nerve, potentially causing a temporary numbness, tingling, or in extremely rare cases, damage to the nerve. However, using live X-ray guidance greatly mitigates this risk by allowing precise needle control. A allergic reaction to the injected medications (anesthetic or contrast dye) is also possible but uncommon. be sure to inform your doctor of any allergies prior to the injection.
Overall, when facet injections are performed with proper technique, these significant complications are few and far between. Doctors consider facet injections to have a moderate to low risk profile in the spectrum of medical procedures.
To put it in perspective, facet injections have been used for decades and are standard practice in pain management – their safety track record is well established. You will typically be asked to sign an informed consent form acknowledging these risks, but your healthcare team will also take numerous precautions to ensure the procedure is as safe as possible. If you have concerns about any specific risk (for example, if you’ve had a bad reaction to a steroid before, or you are prone to infections), discuss them with your doctor. In most cases, the potential pain relief and diagnostic benefit from the injection far outweigh the small risk of adverse effects.
Common Questions about Facet Joint Injections
What do facet joint injections do?
Facet joint injections primarily provide pain relief and help confirm the source of your pain. The injected local anesthetic works almost immediately to numb the nerves in the facet joint area, often resulting in a quick reduction in pain during the first few hours after the shot. This is why, right after the procedure, your doctor may ask you to move your back or neck, if your usual pain is gone or significantly reduced, it means the injection “did its job” by numbing the facet joint, indicating that particular joint was causing pain. The second component of the injection, the corticosteroid, doesn’t have an immediate effect on pain, but over the next few days it will start to reduce inflammation in the joint. By decreasing swelling and irritation around the facet joint, the steroid can lead to longer-lasting pain relief that persists for weeks or months after the numbing medicine wears off.
In practical terms, when successful, a facet joint injection does a few important things: it eases your pain, potentially allowing you to move better and participate in physical therapy or normal activities with less discomfort, and it helps your doctor pinpoint the pain generator. If you feel significant relief for the first day or so (while the anesthetic is active) but then your pain returns once the numbing fades, it strongly suggests the facet joint is indeed the source of pain. Doctors interpret this as a positive diagnostic outcome, it means the facet joint injected is likely causing your symptoms, even if the steroid hasn’t kicked in yet. On the other hand, if your pain does not improve at all in that initial window after the injection, it implies that the facet joint may not be the culprit, and your doctor will investigate other possible causes.
Aside from diagnosing, the main thing facet injections “do” is provide a window of relief. Many patients find that their pain goes from, say, a constant 7 out of 10 to a very manageable 2 or 3 out of 10 after the injection, which can be life-changing during the weeks it lasts. This relief can allow you to sleep better, wean off some oral pain medications, and generally improve your quality of life. It’s important to maintain realistic expectations: the injection is not a permanent cure, but it does offer a therapeutic respite. For some patients, a treatment plan may involve two or three injections given several months apart. If these injections prove beneficial, they can be repeated a few times each year as necessary. And if they work very well, you and your doctor might decide to simply use them intermittently to control pain long-term. If they only help briefly, you might move on to other interventions. In short, facet joint injections help to decrease inflammation and interrupt pain signals in the facet joints, providing relief and also helping to determine if these joints are the origin of your neck or back pain.
How does a facet joint injection work?
A facet joint injection works by delivering powerful medication directly to the site of pain and interrupting the pain signals from that joint. Here’s how facet injections work in simple terms: The local anesthetic in the injection (like lidocaine) bathes the tiny nerves in and around the facet joint, preventing them from transmitting pain signals to the brain. It essentially causes a temporary nerve block. This is why you feel numb or significantly relieved in the affected area shortly after the injection. At the same time, the corticosteroid included in the injection acts as a strong anti-inflammatory medication. In a painful facet joint, the lining of the joint and surrounding tissues are often inflamed (swollen and irritated), which contributes to the pain. The steroid acts on the immune cells and inflammatory chemicals in that region to reduce swelling and inflammation. Over the next several days, as the inflammation goes down, the joint becomes less irritated and painful. The steroid also has a longer-lasting effect than the anesthetic, which is why the goal is for pain relief to continue even after the numbing medicine wears off. In essence, the anesthetic gives you immediate relief, and the steroid provides sustained relief.
Additionally, facet injections work under the guidance of imaging to ensure the medicine is placed exactly where it needs to go. This precise placement is a key part of how they work effectively – by using X-ray or ultrasound, the doctor can navigate the needle to within the joint space or right around it, so the medications are delivered to the exact spot of inflammation. This is what sets injections apart from systemic treatments: the medicine isn’t diluted through your whole body; it’s concentrated at the source of pain. As a result, even a small dose can have a big effect locally. As mentioned earlier, facet joint injections also serve as a diagnostic block to pinpoint the exact source of pain. If the immediate numbing of the joint stops the pain, that mechanism tells the medical team that the facet joint was responsible for generating that pain. If the pain doesn’t stop, it tells them that numbing that joint had no effect, so something else must be at work.
To put it succinctly: a facet joint injection works by temporarily turning off the pain signals from a problematic facet joint and calming the inflammation that is causing those pain signals in the first place. This one-two punch, nerve numbing and inflammation reduction is what provides relief. The procedure’s success hinges on accurate targeting (hitting the right joint) and the body’s response to the steroid. When it works as intended, the facet joint injection can significantly decrease pain and improve function in the affected spine segment, confirming the diagnosis and helping you feel better without the need for invasive surgery.
Conclusion
Facet joint injections provide a precise, minimally invasive method for both identifying and relieving pain that originates from the small joints in the spine. In summary, this procedure involves injecting an anesthetic and steroid into the facet joint, which can quickly numb the pain and reduce inflammation, often providing significant relief for a few months. For many patients, facet injections can be a game-changer – reducing chronic neck or back pain enough to resume daily activities and physical therapy. Equally important, a positive response to the injection confirms that the facet joint was the source of pain, guiding further treatment.
