What it is
Your spine has small joints — facet joints — at every level, on each side. They guide and limit motion and they wear out with age and use, just like any other joint. Inflamed or arthritic facets are a common, often-missed source of axial back and neck pain.
A facet joint injection places a small dose of a numbing medication around the small medial branch nerves that supply the small facet joints at the back of your spine. This serves to confirm that the facet joint is the actual pain source, and the pain relief may be limited to only a few hours. Even with a limited time of at least 80% improvement in the area of treatment, this is a strong predictor that you are a candidate for a longer-term treatment called radiofrequency ablation (RFA).
Often a stepping stone to longer relief. If facet injections give you significant short-term relief, you're typically a strong candidate for radiofrequency ablation — a related procedure that can deliver six to eighteen months of relief at a time.
Who it helps
You may be a candidate if you have:
- Axial (centered) back or neck pain — often deep and aching
- Pain worse with extension (arching backward), twisting, or standing
- Pain that improves with sitting forward or lying down
- Pain that hasn't responded to medication, PT, or other conservative care
- Imaging or exam findings suggesting facet arthropathy
What the procedure looks like
Pre-Procedure Visit
We confirm the diagnosis, review your imaging, talk through what to expect, and give you clear instructions on medications to pause beforehand.
Day of the Procedure
You'll be positioned face-down on a procedure table. The skin is cleaned and a small amount of local anesthetic is used to numb the area.
Image-Guided Injection
Using live X-ray (fluoroscopy), we place the medication precisely into or alongside the target facet joint. Each level takes only a few minutes.
Brief Recovery
You'll rest for about 15 to 30 minutes while we make sure you feel well. Most patients go home within an hour of arriving.
Follow-Up & Next Steps
We track your response over the following days and weeks. Strong relief often points toward radiofrequency ablation as the next step for longer-lasting benefit.
Risks and what to watch for
Facet injections are considered safe when performed under image guidance by experienced physicians. The most common side effects are mild and short-lived: temporary soreness at the injection site, a brief flush, or a few days of slightly elevated blood sugar in patients with diabetes.
Serious complications are rare. Call us right away if you develop fever, severe headache, new weakness, or any signs of infection at a procedure site.
What to expect afterward
- Take it easy the rest of procedure day — no heavy lifting or strenuous activity
- Most patients return to normal activities the next day
- Plan to start or resume physical therapy when your pain has eased
- Track your pain in a simple log — it helps us judge how well the injection worked and guides next steps
Frequently asked questions
How long does relief last?
It varies widely — anywhere from a few days to several months. The first injection often functions as both a diagnosis and a short therapeutic window. Patients who respond well are often candidates for longer-lasting RFA.
Will the injection hurt?
You'll feel a brief pinch from the local anesthetic, then mostly pressure. Most patients are surprised at how quick and tolerable the procedure is.
Can I drive home afterward?
If you've had any sedation, no — bring a driver. With local anesthetic only, most patients can drive themselves; we'll confirm at your visit.
Is it covered by insurance?
Yes, in most cases — including Medicare. We verify your specific coverage before the procedure so there are no billing surprises.
What if it doesn't work?
That's still useful information. If a properly placed facet injection doesn't relieve your pain, the facet joints probably aren't the main pain source — and that points us toward other targeted options.