Back pain is one of the most ubiquitous forms of pain, with a laundry list of potential causes and problems. While often innocuous, some forms of back pain can indicate a growing bone health problem, autoimmune condition, or severe nerve issue. From muscular degeneration to spinal disc conditions to nerve problems and tumors, identifying the cause of your back pain should be your number one priority. Diagnostic tools are an essential part of determining the origin of your pain. Some of these are more straightforward, such as routine physical examinations and imaging tests. Others involve medication to pinpoint and eliminate potential causes of back pain, such as nerve blocks and facet joint injections.
What Are Facet Joint Injections?
A facet joint injection can help you experience relief from your pain or eliminate your facet joints as a potential cause of your back pain. Your facet joints are a series of joints between the articular processes of two vertebrae. These articular processes are bony protrusions that serve to fit into each other, allowing for rigidity and limited motion in the spine.
Between the facet joints of each vertebra are a cartilaginous surface and a capsule filled with synovial fluid, not to be confused with the larger spinal discs that space out each vertebra. Facet joints are innervated by pain-sensitive spinal nerves and can cause back pain after an acute injury, chronic inflammation, or related spinal condition. Facet joint injections are both a form of treatment and a diagnostic tool.
A facet joint injection allows a pain specialist to determine whether inflammation around or in the facet joint is contributing to a patient’s pain. If their pain significantly lessens or goes numb after the injection, the facet joint may be the primary target for continued treatment. Facet joint injections usually involve an anesthetic and an anti-inflammatory corticosteroid if the joint requires more treatment. Facet joint injections are sometimes also referred to as facet blocks.
Cervical vs. Thoracic vs. Lumbar Facet Joint Injections
Facet joints are distinguished by the three major portions of the spine in which they might be located:
- The cervical facet joints are the facet joints of the neck. Pain from a facet joint in the neck may affect the head, neck, or arms.
- The thoracic facet joints are the facet joints of the upper back. Pain from a facet joint in the upper back may affect your ribs, chest, upper back, and, in some rare cases, the arms.
- The lumbar facet joints are the facet joints of the lower back. Pain from a facet joint in the lower back may affect your legs, buttocks, and hips.
A lot of leg and arms pain associated with spinal conditions, such as swelling near the facet joints, may be unilateral, meaning it affects mostly one side.
When Are Facet Joint Injections Required?
In general, facet joint pain may be recognized by long-term pain symptoms in the neck, chest, back, shoulders, arms, or legs without any other sign of injury. Facet joint pain is more common in patients with osteoarthritis or other arthritic conditions. Certain risk factors may accelerate the deterioration of the cartilage between facet joints, and cause pain and bone spurs, including excessive smoking, sedentary lifestyles, and obesity.
Mechanical stress to the back, whether from an injury or chronic stressors, can also predict the onset of a facet joint problem. A doctor who suspects that your facet joints may be the root cause of your pain may utilize a facet block and imaging (through fluoroscopy) to determine whether your facet joints are related to the pain you are experiencing. Imaging may reveal inflammation in the area, bone spurs (unwanted bone growth), or degenerated cartilage.
Facet joint injections themselves are not meant to be a reliable long-term solution. When a facet joint is involved in a patient’s condition, their underlying conditions – an injury or an arthritic flare-up – must be addressed. Facet joint injections are often the first step on the road to recovery, involving other medication (usually over-the-counter anti-inflammatories and painkillers), physical therapy and rehabilitation, and, if applicable, lifestyle interventions.
The Procedure Process
A facet joint injection is a non-invasive and simple procedure. Rather than strictly clinical, facet joint injections, or facet blocks, are often performed in an ambulatory surgical center or the doctor’s office. Most of the time, facet joint injections are done through the help of fluoroscopy, a method of x-raying that involves utilizing a unique and harmless contrast dye to make guiding the injection needle much more manageable.
The patient will generally lie on their stomach and chest for this injection. No sedation is required, but if suggested or requested, the patient may be given an IV injection of a sedative to calm them down. First, a local anesthetic is applied to numb the injection site. Then, the first injection applies the dye to the target area. An x-ray machine allows a doctor to carefully guide their needle into the target area, which would be the facet joint of two vertebrae.
Once the injection site has been properly identified and the needle has been guided towards the right area, an anesthetic and an anti-inflammatory drug are injected into the joint. This is usually an opioid and a corticosteroid (such as lidocaine and cortisone). After the injection, the patient will be asked to remain on the table and rest for a few minutes to prevent any leaking or bleeding. The injection site will be patched up with a band-aid or gauze. There may be some bruising afterward.
Aftercare and Recovery
Once a patient has successfully received their injection, relief may come immediately or after a few hours. If there is no pain relief, the origin of the pain may be different than the doctor had presumed. The length of the relief also differs. It can last hours or days, or longer. In general, patients should not drive after a facet block. They will be asked to remain in a recovery room for up to half an hour for observation. Patients can generally resume normal activities 24 hours after the injection. If a patient’s injection site becomes uncomfortable, an ice pack may be recommended to reduce swelling. Specific symptoms call for an emergency, however, including:
- Sudden numbness
- Fever
- Nausea
- Signs of infection
- Worsening pain symptoms
- Rapid loss of feeling or strength
- Loss of bowel control
Complications are rare with a facet joint injection. These are routine injections that pain specialists and doctors perform very often. However, it helps to be aware of what could go wrong and when to call your doctor.
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