Facet joint injection

Overview

A facet joint injection is a procedure where a small amount of medicine (usually a combination of a numbing agent and an anti-inflammatory) is injected into the facet joints of the spine. These joints are located between the vertebrae and help with flexibility and movement. The injection can help diagnose where pain is coming from and provide relief for pain caused by arthritis or injury.

Facet joint injections are a common treatment for back and neck pain, especially when pain is linked to arthritis in the spine.

This procedure is often used for adults with chronic low back or neck pain, particularly those with osteoarthritis of the spine. It may also be used for people who have had a spine injury.

Symptoms

Common symptoms

• Deep, aching low back pain that gets worse with bending backward or twisting
• Pain in the buttocks or upper legs (but not below the knee)
• Neck pain that worsens with looking up or turning the head
• Stiffness in the spine after sitting or standing for long periods

Symptoms in children

• Facet joint injections are rarely used in children; symptoms of spinal pain in children should be evaluated by a doctor first.

Symptoms in older adults

• Older adults may have arthritis-related facet joint pain that feels like a dull ache in the lower back or neck.
• Pain can be worse in the morning or after inactivity.

Causes

Main causes

• Facet joint pain is often caused by osteoarthritis - wear and tear of the cartilage in the joints.
• Injury to the spine, such as from a fall or car accident, can strain the facet joints.
• Repetitive motions or poor posture over time can irritate the joints.

Risk factors

• Age over 50
• Previous spine injury or surgery
• Jobs or activities that involve repetitive twisting, bending, or heavy lifting
• Being overweight or obese
• Poor posture or weak core muscles

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe back pain along with difficulty moving your legs or loss of bowel/bladder control, seek emergency care immediately.

Book a routine appointment if:

• If you have had back or neck pain for more than a few weeks that does not improve with rest and over-the-counter remedies
• If the pain affects your daily activities or sleep

Diagnosis

A doctor diagnoses facet joint pain by taking your history, performing a physical exam, and often using imaging tests. A diagnostic facet joint injection can confirm if the joint is the source of pain.

Tests that may be done

• Physical exam: your doctor will move your spine and check for pain with certain positions.
• Imaging: X-rays, CT scans, or MRI can show arthritis or injury in the facet joints.
• Diagnostic injection: a small amount of numbing medicine is injected into the joint. If your pain goes away temporarily, the facet joint is likely the cause.

What to expect at your appointment

If a diagnostic injection is suggested, you will go to an outpatient clinic. You will be awake, and the doctor will use X-ray guidance to place the needle precisely. The injection itself takes only a few minutes. You may feel slight pressure but not sharp pain. Afterward, you will be monitored for a short time and then can go home.

Treatment

Treatment for facet joint pain starts with simple steps like rest, ice/heat, and gentle movement. If pain persists, your doctor may suggest physical therapy and over-the-counter pain relievers. Facet joint injections are an option when these do not provide enough relief.

Self-care at home

• Apply ice or heat to the painful area for 15-20 minutes several times a day.
• Try to stay active with gentle walking or stretching, avoiding movements that hurt.
• Practice good posture when sitting, standing, and sleeping.
• Maintain a healthy weight to reduce stress on your spine.

Medical treatments

If self-care and physical therapy are not enough, your doctor may recommend facet joint injections. These are usually done in a clinic and can provide pain relief for weeks to months. The procedure involves injecting a local anesthetic (to numb) and a corticosteroid (to reduce inflammation) into the joint. Some people need more than one injection. Long-term use is not recommended because the benefits may decrease over time.

When is surgery considered?

Surgery is rarely needed for facet joint pain. If injections and other treatments do not help and the pain is severe, a procedure called radiofrequency ablation (using heat to stop the nerve from sending pain signals) or spinal fusion may be considered. Surgery is usually a last option after trying many nonsurgical treatments.

Living with this condition

Living with chronic back or neck pain can be challenging. After a facet joint injection, you may have immediate relief, but it can take a few days for the full effect. Keep a pain diary to track what activities make pain better or worse.

Lifestyle tips

• Stay as active as your pain allows. Gentle exercise like walking or swimming is good.
• Learn proper body mechanics – lift with your legs, not your back.
• Use supportive chairs and take breaks if you sit for long periods.
• Quit smoking, because smoking can worsen spine health.

Diet and exercise

A balanced diet rich in fruits, vegetables, and lean proteins helps keep your weight in check, which reduces strain on your spine. Exercises that strengthen your core (belly and back muscles) can support your spine. A physical therapist can show you safe movements.

Mental health and emotional wellbeing

Chronic pain can cause frustration, anxiety, and depression. It is normal to feel down when pain limits your life. Talking to a counselor or joining a support group can help. Your healthcare team can refer you to mental health resources.

Prevention

It is not always possible to prevent facet joint arthritis, but you can reduce your risk by staying active, maintaining a healthy weight, and using good posture and body mechanics.

Screening programmes

There is no routine screening for facet joint pain. However, if you have risk factors or symptoms, talk to your doctor.

Complications

If left untreated

• Pain may become chronic and affect your quality of life.
• You may develop muscle weakness or stiffness from avoiding movement.
• Long-term pain can lead to depression and social isolation.

Long-term outlook

For most people, facet joint injections offer good short-term pain relief, allowing them to participate in physical therapy and return to activities. The pain may come back after a few months, but the injection can be repeated if needed. Some people find lasting relief with lifestyle changes and exercise. Surgery is rarely needed, and most people manage well without it.

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