Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back.
Facet Joints and Pain
A thoracic Facet Joint Injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.
Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief:
- Diagnostic goal: By placing numbing medicine into the facet joint, the amount of immediate pain relief experienced by the patient will help determine if the facet joint is a source of pain. If complete pain relief is achieved while the facet joint is numb, it means that joint is likely a source of pain.
- Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief.
The injection procedure may also be called a Facet Block, as its purpose is to block the pain.
Facet Joint Anatomy
The facet joints are paired joints in the back and neck, one pair at each vertebral level (one joint on each side of the vertebrae). These joints have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule that is filled with synovial fluid, which reduces the friction between bones that rub together.
Thoracic facet joints are in the upper back. Depending on which joints are affected, pain can be located in different areas of the body:
- Thoracic facet joints. Pain caused by thoracic facet joints (in the upper spine) is typically felt in the upper back, chest and/or arm (rarely).
Why are facet joint injections helpful? If the joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The cervical facet joints can cause pain in your head, neck, shoulder or arm.
A facet joint injection serves several purposes. First, by placing numbing medicine into the joint, the amount of immediate pain relief you experience will help confirm or deny the joint as a source of your pain. That is, if you obtain complete relief of your main pain while the facet joints are numb, then these joints are likely your pain source. Furthermore, time-release cortisone will be injected into these joints to reduce any presumed inflammation, which can, on many occasions, provide long-term pain relief.
What will happen to me during the procedure? An IV will be started so that adequate relaxation medicine can be given, if needed. After lying on an x-ray table, the skin over the area of the spine to be treated will be well cleansed. Next, the physician numbs a small area of skin with numbing medicine (anesthetic), which stings for a few seconds. Next, the physician will use x-ray guidance to direct a very small needle into the joint. He then injects several drops of contrast dye to confirm that the medicine only goes into the joint. A small mixture of numbing medicine (anesthetic) and anti-inflammatory cortisone is then slowly injected.
What should I do after the procedure? 20-30 minutes after the procedure, you move your area of usual discomfort to try to provoke your usual pain. You report your remaining pain (if any) and record the relief you experience during the next week in a “pain diary” we provide*. You may or may not feel improvement during the first few hours after the injection. This depends on if the joints injected are your main pain source.
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The pain diary is an important component of your care. It helps your treating physician to be informed of your results so future tests and/or needed treatment can be planned.
How will I feel after the procedure? On occasion, the part of your treated spine may feel slightly weak or odd for a few hours after the injection. You may notice a slight increase in your pain lasting for several days, as the numbing medicine wears off before the cortisone becomes effective.
Ice is typically more helpful that heat during the first 2-3 days after the injection.
You may begin to notice an improvement in your pain 2-5 days after the injection. If you do not notice improvement within 10 days after the injection, it is unlikely to occur.
Can I take my regular medications after the procedure? You may take your regular medications after the procedure, but try to limit any pain medications for the first 4-6 hours after the procedure. This will ensure that the diagnostic information obtained from the procedure is accurate.
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You may be referred for physical or manual therapy after the injection while the numbing medicine is effective and/or over the several weeks while the cortisone is working.
When can I resume activity? On the day of the injection you should not drive and should avoid any strenuous activities. On the day after the procedure, you may return to your regular activities.
When your pain is improved, start your regular exercise in moderation. Even if you are significantly improved, gradually increase your activities over 1-2 weeks to avoid recurrence of your pain.