Pain, when it is excruciating and generally constant, is a terrible fact of life. For many Americans, it is a brutal day-to-day reality. Chronic pain is becoming more common in the United States, and many people throughout the developed and developing world struggle with symptoms of chronic pain, either due to terminal disease, age, injury, degenerative diseases, genetic diseases, or lifestyle diseases.
Many things can cause chronic pain, and some of the most common forms of pain originate due to damage and degeneration in the spine, especially around the lower back. Out of all forms of chronic pain, it is back pain that is most prevalent in this country.
Managing Chronic Pain
Thankfully, pain can be managed. There are soft and constant ways of managing pain, such as changing certain lifestyle choices to help the body better combat the origin of the pain. Strengthening the right muscles, observing the right postures, and eating the right things can prevent a great deal of suffering in some cases. Then, there are several other management tools that can also be effective, such as regular massage therapy, and even psychotherapy.
Past the spectrum of physical and mental therapy lies pharmacology, where the application of medicine can help a person better manage their pain. In conjunction with other pain management tools, patients are given access to painkillers to help deal with the symptoms of the pain, or to provide short-term relief. Medications can range from NSAIDs and acetaminophen, to opioids.
Finally, there’s the spectrum of medical interventions. Numerous different procedures exist to help patients deal with severe acute and chronic pain, including the installation of pumps to send medicine directly into the spine, the surgical removal of lesions, and the use of injected nerve blocks. In cases where these interventions are necessary, they can provide incredible relief and help a person who would otherwise be debilitated and disabled by their pain continue to live a normal life. One such procedure particularly meant to help figure out if facet joints are causing your lower back pain – the most common kind – is the facet block injection. Through this procedure, a doctor can learn more about the exact cause and pathology of your pain, and how best to help you through it.
What Are Facet Joints?
Facet joints are very small little pieces of bone that connect each vertebra with one another. It’s through the facet joints, which are lined in cartilage, that your spine can bend, twist, and move. A flexible spine is one of the reasons why we’re as mobile as we are – but while the spine is flexible, there are many things that might cause a facet joint to be the culprit of your pain.
Wear and tear, extra weight, aging, injury, and degenerative disease are some of reasons why the cartilage around the facet joint may wear thin, limiting its range of motion and eventually leading to chronic pain, especially the kind that radiates outward from the back. Because there are several potential reasons why your spine might hurt, a facet block injection is often used to determine where exactly the pain is coming from, and whether your facet joints are the source.
How Facet Block Injections Work
Facet block injections are simple procedures. You begin by lying on your belly, while a very thin needle is injected very slowly straight into the joint. A live x-ray, also known as a fluoroscopy, is typically used to ensure that the needle doesn’t hit anything else that happens to be there, like a nerve or a vertebra.
If you have trouble relaxing, then an IV line may be started to help you relax through some mild medication. A numbing solution will be applied to your spine, so you probably won’t feel the needle at all, save for a slight pinch. The numbing medicine can sting at first.
Once the needle has reached its mark, the doctor will commonly inject a contrast dye to confirm that it’s injecting in the right place. Then, the same needle is used to inject a very small amount of anesthetic, and anti-inflammatory medication. Lidocaine, cortisone, and other forms of medication might be used.
A bandage is placed over the wound after the needle is removed. Usually, you’ll stay still and refrain from moving for about 20-30 minutes, while the doctor checks to see if everything is okay.
If everything goes right, you should feel relief, signaling that this is a good bet for physical recovery. Relief might kick in during the first few hours, or some time afterward.
Preparing for the Procedure
A few important things to keep in mind – although this is not major surgery, it is still advisable not to eat or drink very much before the procedure, especially the night prior, unless you need a small amount of water to take any medications you need.
Medications you should discontinue until after the procedure include any form of blood thinner, such as Warfarin or Coumadin. Diabetes medication must wait as well. It’s best to speak to your doctor about what medications you’re on, so s/he can give you an idea of what you should and shouldn’t be taking.
What to Expect
Ideally, the pain will go away. If it doesn’t yet, don’t panic. If it wasn’t pain caused by an issue in your facet joints, then it may still be something else in that area. However, if the pain largely subsides, then that’s good. What’s next is very, very important.
You must keep track of exactly how you’re feeling, day by day, from the day you get the procedure done to the day the injection begins to wear off. The nerve block only lasts a certain amount of time. It’s important to know how long it lasts and how well it relieved the pain. These factors will help with deciding the next step in the treatment plan.
After the Procedure
Once the half hour after the injection is up, you’re allowed to leave, but you may not drive yourself home. For the remainder of that day, you cannot drive, expose yourself to heat (especially in the shower or hot tub), or engage in any strenuous activity. Do not play sports at all if possible.
If all goes well, a facet joint block injection can either provide a good temporary solution for serious lower back pain or give your doctor a better idea for your next step.