Facet joint injections are a relatively simple and straightforward procedure used to reduce pain and inflammation, and to confirm a specific diagnosis. The injection is a mixture of corticosteroids and local anesthetics, which is injected into the facet joints to help the bone column flex and extend. It is usually done in an office procedure room or in an outpatient surgical center. First, the skin and underlying tissues are numbed with a local anesthetic injection.
Most patients only feel pressure when the very fine needle is inserted into the facet joint. You may choose to receive intravenous sedation to make the procedure more tolerable. The safest way to perform this procedure is with local anesthesia. You can opt for intravenous sedation, which will help you relax, but you'll always be awake during the procedure to minimize the chance of nerve damage.
You'll follow up with your doctor two weeks after the injection. If you still don't feel pain relief, you may be advised to repeat the injection. If you have a partial benefit but still have residual pain, a third injection may be recommended two weeks after the second. We usually limit the number of steroid injections over a 6-month period to 3 injections.
If you don't get lasting relief after 3 injections, you're unlikely to get long-term relief with a fourth injection. We try to limit the amount of steroids you are given over a 6-month period to reduce the chance of side effects. If you are allergic to corticosteroids, specific local anesthetics, or ionic contrast, tell your doctor. Also, if you are taking an anticoagulant (Coumadin, Plavix, Warfarin, lovenox, aspirin), tell your doctor in advance to help you design a safe plan for the injection. Immediately after the injection, pain may decrease due to the numbing effect of the local anesthetic.
When the local anesthesia wears off, the pain will return and you may have back or neck pain for a day or two. All patients receiving sedation will need to be taken home. Patients who do not receive sedation can usually drive themselves if they so choose. We recommend that patients take it easy for about one day after the procedure. You may want to apply ice to the injection sites to keep it from hurting the next day.
Unless there are complications, you should be able to return to work the next day. It can take up to a week for the steroid to start working. If you don't feel better after 10 to 14 days, see your doctor for further evaluation and discuss different treatments. Does the injection (s) hurt? The procedure involves inserting a needle through the skin and deeper tissues (such as a tetanus vaccine). So, there are some annoyances involved. However, we numb the skin and deeper tissues with a local anesthetic using a very fine needle before inserting the needle into the joint or along the spine.
Most patients also receive sedatives and pain relievers intravenously, making the procedure easier to tolerate. Will I be “expelled” for this procedure? Not. This procedure is performed under local anesthesia. The amount of sedation administered generally depends on the patient's tolerance. What should I expect after the injection? Immediately after the injection, you may feel that the pain has gone away or has decreased. This is due to the local anesthesia injected.
This may last for a variable period of time, depending on the medication that was injected. Keep track of your pain levels for at least 24 hours after the injection, as this information may be needed to help determine the next step in your treatment. This injection may not provide lasting relief, even if the short-term relief is drastic. You may feel some pain at the injection site. How long does the effect of the medication last? It depends on the medication being injected. Your doctor may not tell you how long you can wait for relief, as this may be part of the information that determines if you have responded as expected or if it is a “placebo response”.Who should not get this injection? If you are allergic to any of the medications you are going to inject, you should not receive the injection.
Your doctor may tell you to stop taking blood thinners before the procedure. If you have an active infection, your doctor may postpone the procedure until you are better. You may be a good candidate for facet joint injections if you have facet joint arthritis on X-rays as well as chronic back or neck pain when moving. Rare side effects such as pain at the injection site, nerve damage, bleeding, infection, increased pain and spinal headache may occur after the injection. The most important success achieved with facet injections is rapid relief of symptoms allowing patients to return to being active and resume normal daily activities. You will be lying face down for lumbar facet joints or on your back for cervical facet joints on an X-ray table. The duration of pain relief varies from person to person but if first facet injection provides relief then procedure can be repeated several times in a year.
It has been demonstrated that therapeutic nerve blocks of lumbar facet joint with local anesthesia with or without steroids can be effective in treatment of chronic low back pain caused by facet joints. Sometimes when facet joint tissue becomes inflamed and irritated they cause pain when bending back and facet injections can be surprisingly effective for those patients whose pain actually comes from arthritis or facet inflammation no matter how long symptoms have been present.