The lure of relief from back pain that facet joint injections promise is certainly an attractive one. But do they actually work?
The thought of driving a needle deep into your spine probably doesn't sound like the most attractive idea whether you suffer from back pain or not.
In fact it probably sounds both crazy and scary in equal parts!
But for some people it can be a good idea.
As getting a lumbar facet joint injection can really help them to get relief from their pain.
And for the very lucky few it can sometimes clear up their problems for good.
So how do they work?
These injections numb the pain by blocking the nerves around the facet joint from sending pain signals to your brain.
They also help to reduce inflammation in the area.
And they help your physician to diagnose what's causing your pain and also make your rehabilitation exercises a lot easier to tolerate.
So despite the 'needle in the spine' bit they sound pretty good right?
Unfortunately it's not all good news.
Because these injections are not going to work for everyone.
And if you do get pain relief from them it's only likely to be temporary.
So if you've ever considered getting a facet joint injection to try and get relief from your lower back pain then read on.
As I'll explain the whole process and what it might offer you.
Then you can decide whether it sounds like something you'd like to go ahead with.
What And Where Are Your Facet Joints?
Facet joints are pairs of small joints that link each vertebrae of the spine together.
This means you have them in your cervical spine (neck), thoracic spine (upper and mid-back) and lumbar spine (lower back).
Their main functions are to keep your spine flexible, stable, and to facilitate movement.
And they also help to keep you out of pain.
As they have an outer layer of cartilage and are encased in capsules containing synovial fluid.
This fluid helps to lubricate your joints while the cartilage reduces friction between your vertebrae and prevents your bones from grinding against each other as you move.
However these facet joints are constantly at work and can become damaged due to injury, stress, wear and tear, or arthritis.
And when this happens they can cause you a lot of pain in your back.
As the cartilage can wear away and bone spurs may develop.
- You lose flexibility and range of movement in your spine as friction between your vertebrae increases.
- This can also lead to inflammation in and around the facet joint.
- The bone spurs and decreased space between the vertebrae can pinch on your nerve roots.
- Your spine loses some of it's stability and as a consequence your lower back comes under greater strain.
So when you experience sciatic pain or pain in your lower back or lower limbs, it may be related to the facet joints in your lumbar spine.
And this is when it may be a good idea to try an injection into those joints to block the nerves, reduce inflammation and reduce the pain.
What Does Injecting Your Facet Joints Achieve?
So how does getting a facet joint injection actually help you?
The idea is to inject a small amount of numbing anaesthetic along with an anti-inflammatory steroid medication such as cortisone directly into your facet joints.
Which works to reduce your back pain in two ways:
- The anaesthetic works as a short-term nerve block by numbing the area and preventing pain signals from being transmitted from your facet joint to your brain.
- While the anti-inflammatory medication calms the area down by reducing inflammation around the nerves and the joint which has a longer-term pain relieving effect.
If the injections work then these pain relieving effects usually last for between a few weeks and a few months.
So they can be a good way to get temporary relief from your pain.
However some people do occasionally experience longer lasting pain relief too.
So with that said here are the 3 best reasons for getting a facet joint injection.
1. It Can Help Your Physician Diagnose Your Problem
Diagnosing the cause of someone's back pain can be like searching for a needle in a haystack.
Because there are so many possible things that may be causing or contributing to it.
So in this way despite the amount of wrong diagnoses and rubbish treatment options I've had prescribed over the years, I do actually feel some sympathy for doctors and physicians.
Because they are not superhuman and won't always have all the answers right away.
But this is where facet joint injections can actually help them.
Because if they think that a certain facet joint may be causing your pain then they have a great way to test their theory.
As by numbing it they can tell by your experience of pain afterwards whether it really was the problem or not.
So if you experience partial or total pain relief after your facet joints have been numbed then bingo this is what needs to be fixed.
And if the injections give you no relief from the pain then the search for the needle in that haystack continues.
But at the very least it's a good way of eliminating possible causes.
2. It Can Give You Pain Relief
As I mentioned in the opening, by injecting your facet joints with a mix of numbing anaesthetic and an anti-inflammatory steroid medication some people can get great pain relief.
As it allows your nerves to get a welcome break from the pain and irritation allowing them to relax and heal.
And it reduces inflammation around the joint which may be pinching on your nerves causing you pain.
Finally this break from back pain makes it easier to stay active.
And being more active will strengthen and increase the health of your back which will keep you out of pain too.
3. It Can Help With Your Rehabilitation
Getting over back pain or a back injury can be hard work.
And they can be even harder when you are in constant pain all day.
Because your muscles don't get a chance to relax and as such they are constantly tense.
However getting a facet joint injection can help with this.
As the numbing effect will help your muscles to relax and give them a chance to heal and repair.
While the cortisone will reduce inflammation and make it easier to carry out your rehabilitative exercises.
This will also help you to become and stay more active in life in general which is a great way to prevent back pain from re-occurring.
What Does Injecting Your Facet Joints Involve?
So if you do decide to take the plunge and get your facet joint injections what are you going to be in for?
The less squeamish among you can see exactly what's involved by watching the video below.
But for everyone else read on and I'll take you through the before, during and after stages of getting a facet joint injection.
All in all the whole process is fairly straightforward and should take about an hour from start to finish.
The Facet Joint Injection Itself
Unlike other medical procedures you don't need to prepare yourself too much for a facet joint injection.
In fact you can even get it done during your initial consultation and you usually stay awake while it is carried out.
The actual injection part takes about 15-20 minutes and goes as follows:
- Firstly you'll get your blood pressure taken and be asked to get changed into a hospital gown.
- Then you'll lie face down on a table and your physician will numb the area of skin where the injection will take place.
- This is done by injecting a small amount of local anaesthetic.
- Once the area is numb the physician will guide the needle into your facet joint using live X-ray (fluroscopy).
- To make sure that the needle is in the right place a small amount of contrast dye will be injected and checked on the live X-ray.
- Once they are satisfied that it is in position they will then inject the combination of anaesthetic and anti-inflammatory medication into your facet joint.
Once the facet joint injection is completed you will have to wait a little while before you can leave.
- You'll be left to rest on the table for around 30 minutes to allow everything to settle down again.
- Your physician will then run through a few movements with you to make sure everything is ok and to see if you feel any immediate differences in your pain levels.
- If that all goes to plan and you feel ok then you'll be free to leave.
- However you may feel a bit weak, numb and woosy for a few hours afterwards so it's not recommended that you drive yourself home. Ask a friend to drive you or get a taxi instead.
The Days and Weeks Afterwards
You can usually get back to doing your regular activities the day after having a facet joint injection.
In fact some people even return to work the same day.
However there are a few things you need to be aware of in the days and weeks after:
- You should avoid any strenuous activity for a few days after your injections. Build up slowly instead.
- It's also a good idea to give driving a miss for the first 24-48 hours.
- You may experience an increase in pain after the first couple of days as the numbing anaesthetic wears off.
- This is because the anti-inflammatory steroids take between a few days and a week to really kick in and work their magic. Once they do this pain should go.
- Your physician will probably also recommend you follow a physical rehabilitation program for a few weeks after the injection to take advantage of the effects of the pain relief.
The pain relieving effects of the steroids should last for at least a few weeks if your facet joints were the cause of your back pain.
However as I mentioned before, not everyone will experience pain relief from these injections.
So Are Facet Joint Injections Worth It?
It would be great to give a definitive answer to that question here but it's impossible.
Because the results of getting a facet joint injection can be hit or miss for a variety of reasons.
So for some people they seem to work like a charm.
Because if the facet joint was what was causing your pain all along then the numbing of the nerves and the anti-inflammatory effect of the steroids can make a huge difference to your pain experience.
And this can leave you feeling great for weeks or months at a time afterwards.
However for others the injections have little to no effect.
This usually signifies that your facet joints weren't the problem to begin with and your search for an answer for your pain has to go on.
And the disappointment that comes when this happens can leave you feeling deflated and a whole lot worse off than before.
So it's a bit of a gamble you take when having these injections.
As you won't know for sure whether they will work for you or not until you've had them done.
So let's take a look at the pros and cons which may help you to come to a decision.
- They can help you (and your doctor) pinpoint the cause of your pain.
- They can block nerve pain from reaching your brain.
- You can reduce inflammation in the area of the facet joint which also reduces pain.
- If the injections work you'll be able to become more active which will strengthen your back.
- They make rehabilitation and physiotherapy easier to tolerate.
- If the facet joint isn't the cause of your pain these injections won't help.
- Your pain may be coming from a variety of places not just the facet joint.
- Even if you do get pain relief it will most likely only be temporary.
- So to keep getting the effect you'd have to have repeat injections every 4 months (which can be costly and a pain).
- The pain relief you feel may even be a placebo effect (although this isn't such a bad thing really).
- Unless you're a character in Trainspotting, getting injected by a needle is rarely a pleasant experience.
Ultimately whether or not you get a facet joint injection is going to be a joint decision between you and your doctor.
While they won't work for everyone and are in no way a miracle cure, they are definitely worth trying if you feel they might be able to help you.
Even if they only end up ruling out another possible cause of your back pain they will have been worthwhile.
Just try not to get your hopes up too much beforehand and treat any improvement as a bonus.
My Own Personal Experience of Facet Joint Injections
I've had 5 operations in total on my lower back and in between each one I was in a lot of pain and discomfort.
It seemed like everything myself and my surgeon were trying to relieve my back pain just wasn't working.
And I can't tell you how frustrated and miserable the whole thing was making me.
I was at the end of my tether and ready and willing to try anything that might help.
So when I found out about lumbar facet injections I really wanted to give them a try.
Because at that stage even a few weeks or months of temporary pain relief sounded like complete heaven.
I purposely didn't allow myself to dream about permanent pain relief in case my dreams were shattered once again.
But I went in optimistic and hopeful that this could at least be a short-term fix.
So how did it go?
Unfortunately for me the lumbar facet joint injections didn't work.
In fact they made me feel a hell of a lot worse!
As for the next two weeks after the injections my back felt a lot more unstable than it usually did.
And I was getting a lot more painful twinges than I was used to.
So it seemed like the injections actually irritated my spinal nerves and muscles rather than numbing and helping them.
However that's not to say that all facet joint injections are bad.
For some people they will be really helpful and could highlight and maybe even solve your back issues.
It was just for me they showed that my facet joints were not the cause of my problems.
After a few weeks the instability and twinges settled down and I was back to my normal level of pain again.
And left me to search elsewhere for my needle.
Are There Any Risks Involved With Facet Joint Injections?
Sticking a needle into your spine is never going to be completely risk-free.
But facet joint injections are only carried out by highly-skilled professionals and remain a minimally invasive procedure that carry very few health risks.
And while any injection carries a risk of infections and causing nerve damage these occurrences are extremely rare.
However there are a few possible side-effects you may experience such as:
- Hot flushes.
- Abdominal cramps.
- Water retention and bloating.
- Increased heart rate.
These effects are also very rare and occur in less than 5% of the patients who get the injection.
And even when they do occur they should only last a day or two at most.
So while getting injected with steroids sounds a bit risky it's fine for most people.
As the amount of steroids used in each injection is very small compared to the dosage people take orally for other ailments.
Do Facet Joint Injections Hurt?
Ok I'm going to finish off here by answering the question that has probably been at the front of your mind since you first heard about facet joint injections.
'Do they hurt?!'.
After all none of us like getting needles right?
Especially into an area where we are already in a lot of pain.
But the good news is that unlike an epidural, a facet joint injection shouldn't really cause you too much pain.
You may feel some slight pressure and discomfort as the injection is taking place.
But the area will be numbed with local anaesthetic beforehand so it should be easily bearable.
And if you do feel a bit too much pain your physician can give apply some more numbing anaesthetic to the area to make you more comfortable.
So don't let fear of needles put you off if you think a facet joint injection may help you.
I hope the information here has given you a better idea of what facet joint injections are all about.
They can be a great way of gaining temporary pain relief that allows you to go about your daily life with more comfort and purpose.
However they are not a miracle cure and they won't work for everyone.
But while they won't cure your pain completely they can help you to build up an active lifestyle that will prevent your pain from returning so strongly in the future.
So talk things through with your doctor first and then decide whether you want to give them a try.
You won't have much to lose either way as even if they don't work they will rule out a possible cause of your pain.
And if they do work then great.
As even a few weeks of pain relief sounds pretty good right?
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