Living with chronic pain is a daily struggle because it’s not easy to find relief. Every patient that comes through the doors of Downtown Pain Physicians in New York, NY is looking for a pain solution that will work for them. The pain medicine specialists at Downtown Pain Physicians understand that managing pain starts with the individual person
We work with each patient to find a pain treatment that will relieve or provide them with lasting pain relief during our initial consultation and pre-procedure visits. Downtown Pain Physicians will not recommend treatment to a patient unless we have evidence that indicates that treatment has the potential to be successful.
What are Facet Joints?
The facet joints, known as zygapophysial joints, or Z-joints, are pairs of bone structures located on the back of each spinal vertebra or spinal column bone. These bones work together to let movement occur between two vertebrae. A capsule surrounding the facet joints keeps them bathed in lubricating fluid. Other joints in the body such as shoulder or knee joints work similarly.
Pain from the joint travels along the medial branches or sensory nerves to the spine and then to the brain when an injury happens. Injuries to the joint can involve the capsule, ligaments around the joint, or the cartilage that covers the end of the bone. The injury can also cause muscle spasms. Depending on where the facet joint injury is, pain can radiate in the lower back, buttocks, neck, and it can cause pain in the back of the head as well as headaches.
The facet joints are divided into three sections. The top part connects the patient’s skull to the torso. This is known as the cervical spine. The middle part attaches the ribs to the spine and is known as the thoracic spine. Where the spine connects to the pelvis is known as the lumbar spine.
Cervical facet joint pain causes neck and head pain. When a patient experiences neck pain, the facet joints in that part of the spine are inflamed. Inflammation causes difficulty in moving the head from side to side or up and down. Pain from these facet joints can occur in your neck and extend all the way down to your shoulder depending on which facet is injured.
Thoracic facet joint pain may feel like muscle tension or as severe pain depending on the injury. This can be caused by injured cartilage inside the joint or by connecting ligaments around the joints. Shoulder, upper back, or hip pain is a common complaint.
Lumbar sacroiliac joint pain can cause nerve pain that travels into the buttocks or back off the upper leg. It can make it hard to sit for long periods and extremely difficult to ride in a car. The area where the pain is felt may also be sore and tender and bending backward may hurt.
Facet Joint Syndrome
Facet syndrome refers to back or neck pain that comes from abnormal spinal facet joints. It can be caused by facet joint inflammation, spinal instability, and arthropathy. The spinal facet joint is the joint weight is put on. It functions as a hinge joint between the two adjacent spinal vertebrae. When functioning correctly, the joint allows seamless and pain-free movement. Injury to these joints causes pain to come from a pair of cervical, thoracic, or sacroiliac facet joints.
Injury to these joints can be caused by degenerative changes in the spine. These changes cause the weight on the spine to be distributed unevenly to the facet joints. As time goes on, this extra weight can result in wear and tear on the facet joints. The capsule around the facet joints begins to thin and the cartilage begins to break down. It starts to become irregular and bone spurs can start to form bone spurs. This creates irritation and inflammation because the joint can’t move as fluidly. As a result, the brain starts to receive pain signals, and, the muscles around the nerve in the spine sending those signals will start to spasm and stiffen.
The difference between facet joint syndrome pain and other types of injuries is that it gets worse as the spine continues to move and engages in activities like lifting, bending, and twisting. If it lasts for more than two weeks, then it’s likely that the pain won’t resolve on its own.
Causes of Facet Joint Syndrome
Facet joint pain does not always occur right away. It may take a specific event for symptoms like pain bending backward or twisting will present itself. They may also be mistaken for disc herniation pain. Patients might feel pain in their arms or legs when bone spurs form and press on the spinal nerves. This pain may flare up or be chronic.
Age, obesity, injuries, repetitive movements, and other spine conditions can contribute to facet joint alignment and cause pain. Patients who have had spine injuries in the past, are prone to arthritis or are between the ages of 40 and 70.
What is a Facet Joint Injection?
A facet joint injection is a procedure that delivers pain medication into the spine. It’s also known as a facet block. It can be used as a method of diagnosing a patient’s pain and to treat what is called facet joint arthritis. They are different from epidural spinal injections which deliver pain medication into the spinal epidural space.
Facet joint injections are injected directly into the facet joint, which is why they are used for pain caused by degenerative or arthritic conditions or injuries. They can be used to treat:
- Lower back injuries
- Spinal stenosis
- Herniated discs
Who is a Candidate for Facet Joint Injection?
Patients who have already tried conservative treatments like anti-inflammatory medications, physical therapy, rest, and chiropractic care and have not had relief from their symptoms may want to try a facet joint injection.
Why Patients Choose a Facet Joint Injection
Facet joint injections offer patients a few main benefits. They serve as a diagnostic tool to help diagnose and treat facet joint pain first and foremost. It’s a minimally invasive procedure that involves injecting anesthetic onto the joint. If the procedure is successful, then it indicates that the facet joints are the cause of the problem.
Facet joint injections also do not require surgery and can be performed by pain treatment specialists during a single appointment in the Downtown Pain Physician’s office. Receiving a facet joint injection can also help patients receive pain relief that lasts long enough to start on physical therapy, which may provide relief from pain in the long term. For other patients, receiving a facet joint injection is another step toward finding the right pain management solution. Recovery time is minimal for facet joint injections compared to more invasive options like surgery.
Preparing for the Procedure
Before your facet joint procedure appointment there are a few things you need to know or do. You should have an MRI or CT scan of your spine before treatment. Notify the doctor if you haven’t had one before the procedure.
At your initial consultation or pre-procedure visit, make sure to tell your doctor about all the medications that you take. This includes prescribed medications, over-the-counter medications, and natural remedies.
If you are taking anticoagulant medications that are designed to thin the blood, protect against heart attack, stroke, and can cause bleeding, talk with the doctor who prescribed those medications about stopping them temporarily. That doctor will tell you when to stop and re-start those medications. They include:
If you have diabetes, your blood sugar may increase due to the steroids used in the injection. Notify your primary care doctor that you’re having this procedure and make a plan to help keep it in its normal range. Do not eat or drink anything for at least eight hours before your procedure. If you take any other medications for a heart condition or high blood pressure, those can be taken at the usual time with a sip of water.
Because you’ll be receiving injections of pain medication, it’s not safe for you to drive as you could experience leg weakness. Make sure to arrange for someone to bring you to the office and bring you home after.
We cannot perform a facet joint injection procedure on patients who:
- Have an active infection including a cold, flu, or fever.
- May be Pregnant.
- Have certain heart conditions.
- Have poorly controlled diabetes.
What Happens During the Procedure
Facet joint injections are not an invasive procedure. On the day of the procedure, you’ll be given a local anesthetic along with an IV with sedation if you need it to help you feel more comfortable. You will lie on your stomach, face-up, or on your side depending on the injection location. Monitoring devices to check your heart rate and breathing may be attached. The skin over the area of treatment will be cleaned to reduce the likelihood of infection.
The doctor will numb an area of the spine using an anesthetic. Then he will insert a special radiofrequency needle with a probe in it into the numbed area. Using X-ray guidance or fluoroscopy, he will direct a small needle into the joint.
Once the doctor is sure the needle is in the right place, he will inject contrast dye into the joint to confirm that it is in and the medication will go into the right place. Next, the doctor will inject the mixture of the anesthetic, like lidocaine or another medication, and an anti-inflammatory, a steroid or cortisone slowly into the joint.
The procedure itself takes approximately 10-15 minutes to complete. Plan to be in the office for 30 to 60 minutes.
How a Patient May Feel During The Procedure
Facet joint injections are relatively painless. But you may feel a little pinch and then a burning sensation as the local anesthetic begins to work and numbs the skin. Once it is numb, you may feel a small amount of pressure at the injection site. Let the doctor know if you experience any pain, and he can inject more of the local anesthetic as necessary.
What to Expect After The Procedure and After Care
Once the facet joint injection procedure is finished, you will rest in the recovery area for 20-30 minutes. During this time, you’ll be asked to move or do activities that would normally cause you pain.
Pain relief may not be immediate. It may take a few hours for the medication to take effect. This depends on whether the pain you feel is caused by the targeted joints. If the correct joints aren’t targeted, or they are not the source of pain, you won’t feel pain relief.
You may feel numb or have a weak feeling or odd feeling in your neck or back after the injection. This is temporary and will usually go away within a few hours. Make sure to talk with the doctor about any questions or concerns you have about your immediate pain or expectations after the procedure.
The doctor may ask you to come in for a follow-up visit after the procedure to determine what progress has been made with your pain.
Don’t drive for 24 hours after the procedure unless the doctor says it is okay to do so.
Recovery Time and Side Effects from the Procedure
After the procedure, avoid doing any strenuous activities. Reduce your pain medication for the first 4 to 6 hours after the injection so that your doctor has accurate diagnostic information.
If the injection is successful, relief from pain should occur within 3 to 5 days. Some patients may experience pain relief sooner or later depending on their case. Resume doing the same types of activities you were doing before your activities. Differentiate between the pain you feel post-injection versus pre-injection. You can return to work the day after the procedure.
You may feel increased pain as the numbing medication that was used begins to wear off. This is an expected side effect of the procedure and you can use ice, Tylenol, or other types of over the counter pain medications to treat it if it’s still painful after the first two days.
Some patients may also feel side effects from the steroid medication. These can include:
- Transient flushing with hot flashes for several days.
- Increased appetite, weight gain, or fluid retention.
- Insomnia, mood swings, anxiety, or irritability.
- Transient decrease in immunity.
- Elevated blood sugar.
- Allergic reaction to the steroid or x-ray contrast..
If you are experiencing any side effects other than what is to be expected after the procedure, contact your doctor, or seek treatment at the hospital as this can be a sign of an adverse reaction.
Risks and Complications associated with Facet Joint Injections
Facet Joint Injections have risks and complications that are relatively uncommon but still important to be aware of. They include:
Allergic reaction to the local anesthetic including rare life-threatening and severe reactions.
Bleeding is a rare complication but patients who have bleeding disorders or take blood-thinning medications.
Injection site pain and worsening pain is usually temporary and lessens after a few days. Rarely, it can get worse and you should seek medical attention immediately.
Nerve or spinal cord damage or paralysis is very rare. But it is possible due to trauma caused by the needle directly on the nerve. Or as a secondary complication from injection into an artery causing a blockage, bleeding that leads to compression, or from an infection.
Statistics or other data
A study of 38 patients was given lumbar facet joint injections. Their baseline pain level averaged 7.3 out of 10 and by 8 weeks post-procedure, their pain level was 2.0.
Patients who received costotransverse joint injections, a joint that causes thoracic back pain reduced their pain from an average of 7.2 out of 10 to 4.5 out of 10. Half of the patients in this study rated their experience as good.
A study conducted with patients who received cervical facet joint treatment showed more than 50% overall symptomatic improvement 1 year after their treatment.
Dr. Raval is very kind and explains everything in layman’s terms, which is super helpful. Thanks so much, guys! 🙂
“PLEASANT AND PROFESSIONAL”
Best doctor visit I ever had. Staff was pleasant and the doctor was very pleasant and professional. Took his time and answered all my questions.
Frequently Asked Questions
Do facet joint injections hurt?
The most uncomfortable part of a facet joint injection is usually a burning and stinging sensation caused by the numbing medication. But we recognize that every patient has a different response to discomfort which is why we can administer a mild sedative to help with anxiety.
How long does the procedure take?
Plan to be in our office for around 60 minutes or slightly longer. The procedure itself takes 20 to 30 minutes followed by a recovery time of about the same length. Your doctor may ask you to move or perform an activity that is normally painful to determine if the procedure worked.
How many injections will I need?
Facet joint injections are not done in a series like ESIs or other types of pain treatments. If you require more injections, those will be scheduled during your follow-up appointment 4 to 6 weeks after the first injection procedure.
What is the recovery time for the injection?
Most patients can return to work the day after the procedure. Don’t drive on the day of the procedure and avoid putting heat on the injection site or bathing for the first day or two. The injection site might be tender for the first few days. Applying an ice pack 3-4 times a day for that time will help alleviate that discomfort.
Are facet joint injection procedures safe?
Yes. There are risks to it just like any other procedure. Make sure you let our office know if you have an active infection, cold, flu, fever, or high blood pressure before or on the day of the procedure. These things can put you at a higher risk for complications, which is why we would reschedule it.
Put an End to Chronic Pain with a Facet Joint Injection
As the best pain management doctors in NYC, Downtown Pain Physicians want to help you relieve your chronic neck and back pain with a facet joint injection. If you’re searching for a pain management solution that will alleviate your pain, call us at 212-404-8070 to schedule your consultation appointment.
Dr. Raj Raval, M.D.
- Board Certified
- Interventional Pain & Musculoskeletal Medicine Specialist
Education & training
- SUNY Downstate PMR Residency
- Rutgers University Fellowship