Overview

The vertebrae (bones that make up your spine) are linked on each side at the back, by facet joints. The facet stabilises the spine, while allowing movement.

These joints can become painful due to 'wear and tear' (degenerative change) or injury. Pain is felt around the facet joints and can spread.

Pain from the joints of the lower back will often be felt in the buttocks and upper legs. Pain from facet joints in the neck can spread into the back of the head, the upper back, and shoulders. When the facet joints are tender and sensitive, the muscles that are close can become tight and painful.

Facet joint injections

Under X-ray guidance, local anaesthetic (to reduce pain in the short term) and corticosteroid (to reduce pain and inflammation in the long term) are injected into the joints to be treated.

Other treatment options

The decision about treatment is shared between you and your doctor. If there are any other treatment options available, your doctor will discuss these with you. Your doctor can give you up-to-date information about the chances of this being a successful treatment for you, and how it fits into the best pathway of care.

If you are undecided about treatment, more advice and information can be provided. Please speak to your doctor about this.

Side effects

As with any procedure, you can get side effects. These are usually minor but there are risks with this procedure. Possible side effects include the following.

Common side effects

• Mild tenderness or bruising at the injection sites, that usually settle over the first few days.

Rare side effects

• The local anaesthetic occasionally spreads, causing some numbness or weakness in your legs and other areas. If this happens, the effect is temporary and will rapidly resolve over minutes or, rarely, hours.
• Infection that might need antibiotic treatment. Seek medical help if there is warmth, redness or tenderness at the injection sites or you feel hot and unwell.

Very rare side effects

• Injured or collapsed lung (pneumothorax) from injections to the thoracic (upper and middle back) area. This is very rare. If you get chest pain or breathlessness, you should get immediate medical help.
• Serious nerve injury is extremely rare (less than 1 in 10,000 cases).

Consent – asking for your permission

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves, and agree to have it.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Before treatment

If your health has changed, it is important to let the department know before the procedure. Let us know if you:

• have an infection in your body or on the skin of your back (your doctor will delay the treatment until the infection is cleared)
• have started anticoagulant or antiplatelet medicines (blood thinners) such as warfarin, rivaroxaban, heparin or clopidogrel (you might need extra preparation)
• suffer from diabetes (steroids might increase your blood sugar, needing monitoring and adjustment of your diabetic medicines)
• take anti-retroviral medicines (these can interact with the steroids)
• have any allergies

You must also tell the doctor if there is any chance that you could be pregnant.

If you are planning to fly or travel abroad within 2 weeks after the injections, please let your doctor know, as we might change the date of the injections.

Make sure that you have made arrangements for someone to collect you after the procedure. If you do not, your procedure will probably have to be cancelled. It is unsafe for you to drive immediately after the procedure. If you do so your motor insurance will be invalid.

Please bring your glasses if you need them for reading.

Bring a list of all of your current medicines, including any you buy from a pharmacy or shop and any herbal or homeopathic remedies.

Continue to take your medicines as usual on the treatment day (unless your pain doctor or nurse has recommended something different). Please contact us at least 2 weeks before your treatment, if you have an infection or are taking antibiotics.

Patients having this treatment do not need to stop taking their blood-thinning medicines. 

During the treatment

Doctors give these injections in slightly different ways, but this is generally what will happen.

• Observations, such as blood pressure and pulse rate, are taken.
• A small needle (cannula) might be placed in the back of your hand.
• You will be carefully positioned and the skin around the injection sites will be cleaned with an antiseptic solution or spray. This can feel very cold.
• An X-ray machine (or other form of image guidance) will be used to make sure we inject you accurately.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will warn you of this first. If you are having sedation (medicine to make you sleep through the procedure) this will not apply.
• The doctor will direct the needles to the areas suspected to be a source of pain.
• When the injections are made, you might feel pressure, tightness or a pushing sensation. If there is any discomfort, let the doctor know.

After the treatment

You will be taken to a recovery ward where nursing staff will observe and monitor you. You will be told when you can get dressed. You will be given help to make sure that you can stand safely after the procedure.

Your pain will be assessed at rest and during activities of daily living, such as walking and moving your back. You will be given more advice before you leave.

Leaving hospital

You can usually leave hospital within a few hours after the injection, and sometimes much sooner. This will depend on how long your doctor or nurse wants you to stay for in recovery.

You should arrange for someone to be with you as you travel home, and stay with you for 24 hours after your treatment. If this is not possible, you should at least have access to a phone.

For 24 hours after the treatment, you should not:

• drive
• operate machinery
• sign legal documents
• provide childcare unsupervised
• drink alcohol

If you are unsure, please discuss these issues with your doctor.

Before you go home you will be given information about who to contact if the pain unit is closed. If you think it is an emergency, please go to your nearest emergency department (A&E) or call 999.

In the days after your treatment, you might have some soreness or aching at the injection site. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular painkillers and medicines as normal and this should settle down.

Please keep the injection sites dry for 24 hours after the procedure.

Try to keep moving about the house, but avoid anything too strenuous.

As your pain decreases, you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone. It is best to increase your activities gradually.

If you are unsure, or finding exercises increasingly difficult, please contact your GP or pain team and discuss a referral to physiotherapy.

Returning to work

This will be different for everyone, and might depend on the nature of your work. You should discuss this with your doctor.

Follow-up appointments

You will receive a letter for a follow-up appointment. It will be a phone call with a nurse specialist, or in clinic with a consultant. If you haven’t heard from us within 10 weeks after the procedure please contact us, phone 020 7188 4714 Monday to Friday, from 9am to 5pm.

Acknowledgements

Adapted from information from the Faculty of Pain Medicine of the Royal College of Anaesthetists, and includes contributions from Addenbrooke's Pain Management Unit, the Chronic Pain Service at St George's Hospital London, Newcastle Pain Management Unit, and the Interventional Specialist Interest of the British Pain Society.