Facet Injections

Performed by top Pain Management doctors in Alaska

A minimally invasive treatment for neck and back pain, facet injections are gaining favor among physicians seeking to find non-surgical solutions to painful and debilitating condition.

Facet injections work by reducing the inflammation and irritation in the facet joints of the spine, where most back pain originates.

Several syndromes are commonly, and effectively, treated with facet injections, including:

  • Herniated disk
  • Sciatica
  • Spondylolysis
  • Spinal stenosis


Facet joints are moveable connections that connect one vertebra, or bone, to another within the spinal cord. Facet injection treatment is achieved by injecting a long-lasting steroid along with an anesthetic such as lidocaine or bupivacaine. Steroids work by reducing painful inflammation within the facet joints, while the anesthetic numbs pain. This combination expands into other portions of the spine, further reducing irritation.

From start to finish, treatment typically takes less than 15 minutes.

Facet injections and epidural steroid injections are similar, but there is one important difference. ESI treatment utilizes medication that is injected into the epidural space; facet injections use medication that is shot directly into joints.


The aspect of facet injections that patients suffering from back and neck pain will find most attractive is the immediate relief of symptoms that are prohibiting, or seriously impeding, their ability to lead an active life. The therapy helps patients resume every day activities that proved difficult using oral medications or physical therapy, or both.

Facet injections have an additional benefit. Treatment can be utilized as a diagnostic test to determine if the facet joints are the actual source of a patient’s pain. If pain is quelled by an injection, then it is clear that pain is emanating from the facet joints. Additionally, lumbar facet joint nerve blocks using local anesthetic, with or without steroids, have proven to be an effective treatment for chronic lower back pain (Manchikanti 2007).

If back pain in unresponsive to the injections, physicians are then able to use the information to make an accurate diagnosis and outline an effective course of treatment.

Evidence-based practice guideline for the management of chronic spinal pain using interventional techniques was developed by the American Society of Interventional Pain Physicians, which provides recommendations to medical professionals and patients in the United States. The ASIPP states that the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain (Boswell 2007).


Facet joint injections are considered a safe, appropriate non-surgical treatment for patients with back and neck pain, but as with any medical procedure, there are some risks.

Those risks can include but are not limited to misplacement of the needle during treatment, or advancing the needle to deeply into the joint, or positioning it incorrectly. Any of these circumstances can cause nerve damage, excessive bleeding, infection or headache after the injection take place.

Patients must also be careful to avoid drug interactions. A reaction could be caused by the medication used in facet injections; complications can also occur if a patient is taking oral corticosteroids. These complications include elevated blood sugars, weight gain, arthritis, stomach ulcers and transient decrease in the immune system.

Before considering facet injection treatment, patients should discuss with their physician all potential risks and benefits of facet injections.


In the past two decades, lumbosacral injections for facet joint pain treatment have increased dramatically among the Medicare population; the treatment continues to be a viable alternative to more invasive treatments (Friedly 2007). Injections are being utilized more frequently because the treatment has provided measurable, positive results in the treatment of back and neck pain.

In a 2007 study of individuals suffering from back pain, it was determined that 53 percent of people who received treatment reported improvement of their pain after eight weeks, and by six months, more than 68 percent improvement (Anand 2007). Although the duration of pain relief varies for individuals, patient generally should receive treatment up to three times per year, if the first treatment is successful enough to justify continuing the injections.

Administered correctly, facet injections have been proven to provide patients with significant level of relief for back and neck pain. For more information about facet injections, book an appointment to find out if the treatment could be a viable option to decrease pain.


  1. Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777
  2.  Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396
  3.  Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236
  4.  Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L;
  5. American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025