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FACET JOINT INJECTIONS
     

Q: WHAT IS A FACET JOINT AND HOW CAN IT GET INJURED?

A: The facet joints are located on the back of the spine, and are often the cause of back and neck pain, and sometimes can be the cause of headaches.  These joints can be painful in individuals who have had whiplash events, have been hurt while bending or twisting while lifting heavy objects, or have “arthritis” of the spine.

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Q: WHAT IS A FACET JOINT INJECTION?

A: The facet joint nerve, also called the medial branch nerve, transmits pain sensations from the facet joint.  These nerves can be temporarily numbed up with a local anesthetic, as a diagnostic test, when we suspect that this structure might be causing your pain. If you obtain temporary pain relief after the test, then the facet joints may be causing your pain.  Sometimes we choose to inject cortisone into the joint itself, along with a local anesthetic to also numb the joint.  This gives us the same diagnostic information as when we block the nerves that supply the joint.  It also can help treat the pain if inflammation is an important part of causing your pain.

Q: WHAT DO YOU DO IF YOU FIND OUT THAT THE FACET JOINTS ARE CAUSING MY PAIN?

A: We can then plan treatment focused on this specific structure.  For example, this changes the kinds of exercises you might do in physical therapy.  We will also usually recommend a long lasting block of the facet joint nerves in which we apply a mild electric current to the nerves.  This procedure can give pain relief for many months or even a few years.  It is it is described in detail on another information sheet titled “radiofrequency neurotomy for facet joint pain.”

Q: WHAT DO YOU DO IF YOU FIND OUT THE FACET JOINTS ARE NOT CAUSING MY PAIN?

A: If you obtain no pain relief after the facet joint nerve block, then we know that the facet joints are not the source of your pain.  We might then recommend a different a different diagnostic injection to try and determine what other structure could be causing your pain.

Q: HOW LONG DOES IT TAKE TO DO THE INJECTION?

A: The injection itself only takes a few minutes.  It actually takes more time to get you positioned comfortably, wash your back off with a sterile soap and set up our supplies for the procedure.

Q: WHY DO YOU USE FLUOROSCOPY (X- RAYS) DURING THE PROCEDURE?

A: We use fluoroscopy so that we can easily advance the needle to a precise location next to each of the facet joint nerves or into the facet joints that are anesthetized during the procedure.

Q: WILL IT HURT?

A: Some parts of this procedure are a little bit uncomfortable.  Most patients prefer doing this procedure with a mild sedative.

Q: WILL I BE ASLEEP FOR THIS PROCEDURE?

A: It is not safe for you to be completely unaware, but we can give you medication so that you are quite relaxed and comfortable for the injection.  Remember also that this is a diagnostic test, to see if we can block your pain, so you need to be awake enough after the procedure to be able to evaluate your pain for the next several hours afterwards.

Q: IS THERE ANYTHING SPECIAL I SHOULD DO ON THE DAY OF THE PROCEDURE?

A: Please do not take pain medications on the day of the procedure.  The facet joint block is a useful diagnostic test only if you are having pain on the day of the procedure. Similarly, if you need to do certain activities to cause your usual pain, such as walking or bending, please do them ahead of time so that you have some pain and we can then test whether or not the injection relieves your pain.

Q: WHAT SHOULD I EXPECT AFTER THE INJECTION?

A: This is a diagnostic test, so we don’t know for sure whether you will obtain pain relief from it or not.  It will be important for you to complete a pain score sheet for the rest of the day and return it to us for evaluation of your result from this injection. You might also have some pain at the injection sites, usually this is mild and lasts a short time.

Q: WHAT SHOULD I DO AFTER THE PROCEDURE?

A: Please do not just go home and rest, instead do some of the usual things which cause you pain, to test whether the block is helping your pain or not.  It is also important that you do not take your pain medications for six hours after the procedure, since we need to know whether any pain relief is due to the nerve block and not your pain medications.  If you were given intravenous medication you will need a ride home and will not be able to drive for the rest of the day. 

Q: WHAT ARE THE RISKS?

A: You might be sore afterward.  There is a rare chance of infection, allergic reaction or nerve injury.  Serious side effects are extremely rare.

Q: WHO SHOULD NOT HAVE THIS INJECTION?

A: You should not have this procedure if you have an infection.  It is safer to wait until after the infection is treated.  If you are on coumadin, plavix, ticlid, or high doses of aspirin we will need to stop those medications in advance of the procedure.

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