Your spine is made up of 24 spinal bones, called vertebrae. Each vertebra has two pairs of facet joints. The facet joints are the small joints between the vertebrae, located in the back of the spine, which link the vertebrae together. A vertebra has one pair of facet joints that faces upward to join with the vertebra above, and another that faces downward to connect with the vertebra below. Facet joints give the spinal column its flexibility, allowing each vertebra to move while keeping the spine properly aligned.
Like all joints, your facet joints are subject to wear and tear, and can deteriorate as you age. They can become swollen or inflamed due to injury, trauma, repetitive movements, arthritis or degenerative diseases of the spine. When the affected facet joints are in your back, this can lead to aches and pains in the lower back, thighs or buttocks. If they affected joints are in your neck, this can cause head, neck, shoulder and upper back pain. The collective term for pain stemming from the facet joints is facet joint syndrome or simply facet syndrome.
Facet joint syndrome can be debilitating. Sufferers often experience severe pain and stiffness, which makes it difficult to walk, stand, or even lie down. Sometimes facet joint pain can be managed with exercise, heat therapy, anti-inflammatory medications and improving posture. However, the more conservative treatments do not provide enough pain relief for everyone. For these patients, a facet joint block may be the answer. This is a procedure Dr. Sonia Pasi offers to select patients at Advanced Pain Consultants.
A facet joint block involves the injection of long-lasting corticosteroid (medication to reduce inflammation and pain) and an anesthetic (numbing medicine) into the facet joint of the spine or the small nerve branches going to the facet joint. The injection can be both a diagnostic tool (a test to see if the pain is coming from this area) and a therapeutic treatment (to relieve the patient’s pain). Two hours after the injection (sometimes a little longer), if the patient has achieved 75 percent or greater pain relief, this means it is likely that this particular facet joint is important in the patient’s pain syndrome. The patient will then return to the clinic for a second visit, usually about a week later, to repeat the facet joint block. This purpose of this visit will be to confirm the diagnosis, as well as to provide continued pain relief.
In general, Dr. Pasi recommends facet joint blocks to patients with neck, arm, lower back or leg pain (sciatica) stemming from inflammation of the facet joints. These patients will have failed to respond to more conservative pain treatments (physical therapy, pain relieving medications, bed rest, heat therapy, back braces, etc.).
Facet joint blocks can help relieve facet joint pain caused by:
Facet joint blocks should NOT be performed on people who have an active infection, are pregnant, or have a bleeding disorder or very high blood pressure. Dr. Pasi will be able to determine whether a facet joint block is right for you during a pre-treatment evaluation.
Facet joint blocks are done in the office and usually takes around 15 minutes to perform. Patients remain awake during the entire process. Dr. Pasi begins the procedure by numbing the injection site with an anesthetic to reduce any potential discomfort. She then inserts the treatment needle directly into the facet joint through the back, using a fluoroscope (an x-ray device) to ensure the needle is placed correctly. Once the needle is in place, the local anesthetic and steroid medication are injected into the targeted joint. More than one facet joint can be tested/treated in a single visit (in cases where more than one facet joint is suspected to be causing pain).
After the injection(s), the needles are removed, the skin is cleansed and bandages are applied. The patient is moved to the recovery area where he or she is monitored for around 20 minutes, before being discharged to go home. Patients can resume their normal activities the next day.
The immediate effect from the procedure is no pain, but this is due to the local anesthetic which was injected, and this will wear off in a few hours. However, in 3 to 5 days, the steroid medication normally starts taking effect. The duration of the pain relief varies from patient to patient, depending on condition of each patient and his or her response to treatment. For some patients, relief only lasts a few days; for others it can last for several months. Still others experience no improvement at all after the injection.
At a follow-up visit, Dr. Pasi will evaluate the results of the patient’s injection and determine whether or not additional treatments are recommended. For patients who do see improvement, additional injections may certainly be worthwhile. A facet joint block can be repeated up to three times a year for patients whose injections produce successful results. Patients who do not experience any pain relief from the initial treatment will not benefit from additional injections.
If you are living with chronic, unmanageable pain from facet syndrome, a facet joint block may be the solution you’ve been looking for. To learn more about facet joint blocks or to schedule an evaluation with Dr. Pasi, please call Advanced Pain Consultants at (919) 510-7901 to book your appointment. Stop letting pain run your life! Take the important first step to getting treatment for your pain by calling us today to request an appointment.