Facet joint injections

Your doctor has requested that you have facet joint injections. This may be to diagnose the cause of your pain or to help relieve your pain. We hope that the following information will answer some of the questions you may have about this procedure.

What are facet joint injections?

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Facet injection

Inflammation of the facet joints may cause pain in the neck, back and/or the arms and legs.

There is usually muscle spasm in the area of the joint close to the centre of the spine (the facet joint). Muscle spasm combined with joint pain can make movements stiff and painful.

A facet joint injection provides important information for your doctor and may also provide you with some relief of pain.

Why do I need to have facet joint injections?

The procedure is designed to prove if the facet joint is causing your pain by placing temporary numbing medicine over the joint of concern. If your pain improves after the injection then that facet joint is the most likely cause of your pain. If your pain remains unchanged, then that joint is probably not the cause of your pain. If you have been given this injection as pain relief then your pain should improve.

What is injected in the facet joints?

The injection is a combination of local anaesthetic (a numbing agent) and steroid (an anti-inflammatory agent). The local anaesthetic works immediately and the steroid begins to work within two to three days.

How do I prepare for facet joint injections?

There is no preparation for this procedure, you can eat and drink on the day of your procedure and take all your medication as normal.

If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran) we ask you to call the Imaging department on 0117 414 9110 as we may need to adjust your medication before undergoing this procedure. These may need to be adjusted to keep the risk of bleeding to a minimum.

Please also inform a member of the imaging team if you are a diabetic as there is a possibility the steroid may affect your blood sugar levels. It is therefore important you monitor your levels carefully for several days after the procedure and consult your GP if necessary. 

What will happen during the procedure?

  • You will arrive at Gate 18 whereby a member of the Imaging team will take you through to the fluoroscopy waiting room.
  • Following confirmation of your details and history you will be shown into the x-ray room and introduced to the staff performing the procedure. You will be cared for by a small team including a radiologist (x-ray doctor) and/or radiographer and an imaging support worker.
  • Before the examination begins the radiologist or specialist radiographer will explain what they are going to do. You will be given the opportunity to ask any questions you may have. If you are happy to proceed you will be asked to sign a consent form.
  • You will then be asked to lie on your front on the x-ray couch. The skin will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
  • A very fine needle will be directed to the facet joint(s) using the x-ray machine.
  • When the radiologist or specialist radiographer is satisfied with the needle position, the local anaesthetic and steroid will be injected.
  • Afterwards you will be asked to sit in our waiting room for 20 - 30 minutes so that we can ensure you are feeling well before you go home.

How long will it take?

You will be awake throughout the procedure, which lasts about 15 – 30 minutes.

Will it hurt?

You may feel a little pressure or discomfort, during the injection of the pain killing medicine. This will last for only a few seconds. You should not drive for the rest of the day. You will need to arrange for someone to take you home. Some people find that their pain feels worse for two to three days after the procedure. This is because the steroid can sometimes irritate the tissue. Don’t worry if this happens, as it will settle down by itself.

Are there any risks associated with facet joint injections?

Generally it is a very safe procedure. Potential complications are uncommon and include:

  • An increase in your pain in the first 24 hours following injection. Should this occur, take your usual or prescribed pain medication and seek advice from your pharmacist or GP if necessary.
  • Bleeding or haematoma (a bruise under the skin) – this should settle down by itself.
  • Infection developing at the injection site. This will happen to less than 1 in 5000 people. Contact your GP if you experience any redness or tenderness at the injection site.
  • Flushing of the face for up to 48 hours after the injection – this should settle down by itself.
  • Skin dimpling or discolouration at the site of the injection – this should settle down by itself.
  • A disruption in your mood – this should settle down by itself.
  • Occasionally women may experience a change in their menstrual cycle. This is most likely due to the steroid but contact your GP if this happens to inform them.
  • If you are diabetic you may notice a rise in your blood sugar levels. It is therefore important you monitor your levels carefully for several days after the procedure and contact your GP if necessary.
  • The procedure uses X-rays to confirm that the needle is in the correct place. The amount of X-rays used is very small however patients who are or who may be pregnant should inform the department before attending for their appointment. 

Finally

We hope this information is helpful. If you have any questions either before, during or after the procedure the staff where you had your procedure will be happy to answer them.

References and sources of further information

The Pain Clinic www.PainClinic.org

www.londonpainconsultants.com/articles/2006/11/16/facet_ joint_injections

www.painprevention.net/facetinjections.aspx

NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution

How to contact us:

Pain Clinic
Gloucester House
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

0117 4147361

PainClinicClinical@nbt.nhs.uk

www.nbt.nhs.uk/painclinic

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published October 2019. Review due October 2021. NBT003242

Facet joint injections