A facet joint injection is a procedure where pain-relieving and anti- inflammatory medications are injected into your facet joints to reduce pain.

The facet joints are small joints located at the back of your spine. Pain in these joints can be caused by wear and tear from years of use.

Many people experience relief after receiving an injection. The procedure is minimally intrusive and has a low risk of serious injuries. Read on to learn more about the injections, their side effects, and the cost.

An illustration of the location of a facet joint injection, along the spine.
Illustration by Sophia Smith

Facet joint injections treat pain originating from the facet joints in your neck or back. According to 2021 research, it’s estimated that facet joint pain is the source of spine pain in up to:

  • 67 percent of people have neck pain.
  • Almost half of people have back pain.
  • 45% of people have back pain.

Facet joint injections contain medications called steroids that help reduce inflammation. They also contain lidocaine or other pain relievers.

Your doctor may recommend these injections if your pain does not respond to conservative treatment like physical therapy or modifying your activity levels for at least 3 months.

Potential causes of facet joint pain include:

  • Inflammation.
  • Joint instability.
  • traumatic injury
  • Excess pressure is placed on joint tissue.
  • Joint lining is affected by inflammation.

Facet joint injections can be used to diagnose facet joint pain. The facet joint is the cause of pain according to a positive response to the injections.

Is facet joint injection the same as a nerve block or epidural?

These are all related procedures. An injection of medication into a joint is called an idiosyncrasy facet joint injection.

A facet joint nerve block is a similar procedure. It involves injecting medications near the branches of your medial nerves, which supply sensory information to your facet joints.

An epidural is a nerve block injected into the space surrounding your spinal cord to numb part of your body. It’s used during labor and some types of surgeries.

A facet joint injection is a minimally invasive procedure that usually takes less than 30 minutes. It’s an outpatient procedure, which means you can go home the same day. You’ll be awake during the procedure but may be offered sedation through an IV in your hand or arm.

Here’s an idea of what you can expect:

  1. You will lie on a table and be connected to machines to monitor your vitals.
  2. Your skin will be covered with a drape to prevent it from being contaminated.
  3. Your surgeon will inject a local anesthetic into your skin and numb it.
  4. Using either fluoroscopy (a type of real-time X-ray) or a CT scan as a guide, your surgeon will insert the facet joint injection through your skin and into your joint. They may also inject a contrast dye to make sure the needle is in your joint.
  5. They will inject the steroid into your joint.
  6. They will remove the needle and apply pressure to stop bleeding. There are no stitches required.

How painful is a facet joint injection?

During the injection of local anesthesia, you may feel a pinch and some slight burning as it takes effect. However, it should not cause intense pain.

The injection should not cause any pain since the area will be numbed. You will likely feel some pressure around the injection site.

You may have a little There is pain around the injection site. for a few days after the pain is gone. If you have a lot of pain, your doctor may prescribe a pain relief drug.

Facet joint injections are generally safe, but all medical procedures come with some risks. The most common side effects are:

  • swelling
  • There is pain around the injection site.
  • temporarily increased back pain

The anti- inflammatory drugs used in the procedure are rarely used to cause side effects.

Severe complications are very rare. In a 2020 study, researchers reported 101 complications across 11,980 procedures. Eight of these were considered major. All major complications were related to infection, and one person died of an infection.

Can facet injections make your pain worse?

A facet injection can cause pain. The swelling at the injection site is the cause of this pain.

Once the medication takes effect, it usually goes away. If the area around your injection is sore, you can try putting an ice pack on it for up to 20 minutes at a time.

Facet joint injections generally cost more than $1,000 in the United States. One surgery center in Texas lists their price as $1,276 to $1,458. The exact cost depends on factors such as:

  • The extent of your procedure.
  • Your location.
  • You visit a hospital or clinic.

In a 2018 study, researchers estimated that the direct cost of a similar procedure, a facet joint nerve block, was $758.08. However, this does not cover the cost of drugs and medical therapy. The estimated total cost was 67 percent higher.

Are facet joint injections covered by insurance or Medicare?

According to the Medicare Coverage Database, facet joint injections may be covered if you meet the following requirements:

  • at least 3 months of moderate to severe pain with a functional impairment that has not responded to conservative treatments like nonsteroidal anti-inflammatory drugs or physical therapy
  • pain not associated with impinged nerves
  • There are other non-facet conditions that could explain the pain.
  • Your facet joints are the source of your pain, according to an assessment by a medical professional.

All or part of your procedure can be covered by other insurance providers. It is important that you check your plan before you go.

You will need to avoid strenuous activity and drive for the first 24 hours after the injection because you may have some pain around the site. You will be able to return to your regular activities the next day.

You may experience an increase in pain for a few days after your procedure.

Facet joint injections can potentially offer relief for 3 months or longer. A 2018 review of studies found conflicting evidence on whether they offered pain relief between 3 to 6 months.

Facet joint injections can be repeated up to 3 times per year.

What’s the next step if facet joint injections do not work?

“If your injection doesn’t offer pain relief, it may be because the injection didn’t reach the source of pain or because the pain isn’t caused by your facet joints.”

Your doctor can give you a recommendation. They may suggest trying a different injection or an alternative treatment like radiofrequency neurotomy, where heat is used to destroy the nerves that are causing pain.

A facet joint injection can help reduce pain in the small joints at the back of your spine. It is a minimally-invagant procedure that can help with back or neck pain for a while.

Your doctor can help you decide if a facet joint injection is a good idea. Alternative treatments can be recommended to ease your symptoms.