Pain Service - Facet Joint Injection

If you are on blood thinning medications such as Warfarin, Nicoumalone (Sinthrome), Aspirin, Clopidogrel (Plavix), Ticlopidine (Ticlid), Apixaban, Rivaroxaban then please contact the Booking and Scheduling Department on 0161 778 2233.

What is a facet joint injection?

It is an injection of a mixture of local anaesthetic (medication to temporarily numb the nerves) and steroids (anti-inflammatory medication) into a facet joint.

The facet joints are small weight-bearing joints located in pairs on the back, from the neck to the lower back. The local anaesthetic in the mixture helps to relieve the pain and the steroid reduces the inflammation.

The procedure is carried out carefully under x-ray control to ensure that the injection is in the right place. The injection is given to several of the affected facet joints at any one time. The injection can be given in the back of the neck or in the back, depending on the site of the pain.

The anti-inflammatory steroids should not be confused with the anabolic steroids used by athletes for building up muscle mass. Steroids have been licensed for use in joint spaces and have been is use for many years.

Why is the injection given?

A proportion of your pain may come from stress on the facet joints. The local anaesthetic and steroid mixture should act on the nerves supplying these joints and help to reduce the pain and inflammation from the joint.

The reduction in pain should improve the quality of your life, and can help you perform back strengthening exercises, which is the best way to improve the function of the back over the longer term.

How is the injection done?

You will be asked to come to the Day Surgery Unit.

A cannula (plastic tube) will be placed at the back of your hand. The procedure is done under local anaesthetic (medication to numb the skin). In some circumstances sedation (medication to relax) and other medication such as pain killers can be given through the cannula.

You will be asked to lie on your front. The correct sites for facet joint injections are marked on your back or neck using the x-ray machine.

Local anaesthetic injection is given to numb the skin and further local anaesthetic solution with the steroid preparation is injected into the facet joints. Usually several joints are injected at the same time.

What are the beneficial effects?

Typically there is some injection site pain after the procedure and you may initially experience some increase in your pain. It is usually self limiting and easily controllable with painkillers.

Some patients may complain of slight numbness of the skin overlying the injection site. This is also self limiting.

There may be some local bruising and tenderness on your skin.

Potential side effects with the use of steroids

There are very few side effects associated with single or occasional use of steroid injections.

Hot flushes, feeling sick or having mild abdominal pain are sometime felt. Control of diabetes may be difficult, and menstrual irregularities may occur. These settle in a few days.

Repeated and frequent use has the potential to lead to more serious side effects, but it must be kept in mind that the dose that is used in the injection is very small compared to those people who take steroids by mouth on a daily basis for conditions such as asthma or arthritis.

In those circumstances, side effects such as increase in appetite, weight gain, thinning of the bones (osteoporosis), thinning of the skin, eye problems (glaucoma, cataract), weakness, depression, rounded face, high blood pressure and water retention have been seen. Oral contraceptive pills may alter the level of steroids in the blood.

Advice/precautions

• You will be required to stay in hospital for sometime after the procedure
• If there is excessive or persisting numbness, you may be required to stay in hospital overnight
• A follow-up appointment will be arranged, so that the doctor or nurse can review the effects of the block
• You should carry on with your normal activities, try to increase the exercises and aim to reduce your painkillers if the effect of the injection appears to have been successful
• If there are any concerns or queries, please contact the pain clinic

It is very important that you inform the doctor or secretary in the pain clinic at least one week before the injection if:

• You are allergic to any medications
• You have an infection near the injection site
• You have had a relevant steroid/cortisone injection by another doctor or nurse or if you are on regular steroid joint injections
• You think you may be pregnant
• You are a diabetic on insulin. Your blood sugar may be difficult to control for a few days, tending to be high
• Caution should be exercised if you have had a recent heart attack or vaccination
• If you have been started on new blood thinning medications

Contact Details

Fairfield
Day Surgery - 0161 778 2503
Pain Secretary - 0161 778 3821

Rochdale
Day Surgery - 01706 517132/517133
Pain Secretary - 01706 517705