Facet Joint Blocks or Injections Melbourne

What Are Facet Joint Blocks?

Facet joint blocks or injections, also referred to as facet injections or facet blocks, are minimally invasive procedures used to diagnose and treat pain arising from the facet joints of the spine.

The facet joints are small joints located between each vertebra in the spine, and they allow for movement and flexibility of the spine.

There are two main reasons why you might get facet joint injections:

• Diagnostic Facet Joint Blocks. This is when the injection is primarily used to determine if the facet joints are the source of a patient’s pain. A local anaesthetic, sometimes combined with a corticosteroid, is injected into the facet joint or around the medial branch nerves that supply the facet joint. If the patient experiences significant short term pain relief after the injection, it suggests that the facet joint is likely the source of the pain.
• Therapeutic Facet Joint Blocks. Once the facet joint has been identified as the source of pain, therapeutic facet joint injections can be performed. These injections typically include a combination of a local anaesthetic AND a corticosteroid. The local anaesthetic provides immediate pain relief, while the corticosteroid reduces inflammation and provides longer-lasting pain relief.

Facet joint block or injections are often part of a comprehensive treatment plan that may include physical therapy, medications, and other interventions to manage spinal, neck and back pain effectively.

What Conditions Do Facet Joint Blocks Treat?

Pain in your spine, neck, or back can be caused by various factors and conditions that affect your facet joints. Here are some common causes:

• Degenerative Changes. As we age, the facet joints can undergo wear and tear, leading to osteoarthritis. This degeneration can cause the cartilage in the joints to deteriorate, resulting in pain and inflammation.
• Injury or Trauma. Accidents, falls, or sports injuries can damage the facet joints, leading to acute pain. Fractures or dislocations involving the facet joints can also cause significant pain.
• Poor Posture. Prolonged periods of poor posture, such as slouching or sitting in a hunched position, can put extra strain on the facet joints, leading to pain over time.
• Overuse or Strain. Repetitive motions or heavy lifting can strain the facet joints, leading to inflammation and pain.
• Spinal Conditions. Conditions like spinal stenosis (narrowing of the spinal canal), spondylolisthesis (slippage of one vertebra over another), or herniated discs can indirectly affect the facet joints and cause pain.
• Inflammation. Inflammatory conditions like rheumatoid arthritis or ankylosing spondylitis can affect the facet joints, leading to pain and stiffness.
• Mechanical Stress. Abnormal mechanical stress on the spine due to factors like obesity or improper body mechanics can contribute to facet joint pain.
• Genetics. Some people may be genetically predisposed to develop facet joint problems or osteoarthritis, leading to facet joint pain.
• Post-Surgical Changes. Previous spinal surgery can sometimes alter the biomechanics of the spine and lead to facet joint pain.

It’s essential to consult with a pain management doctor for an accurate diagnosis and appropriate treatment plan if you’re experiencing facet joint pain. 

Your doctor can help identify the underlying cause of the pain and recommend the most suitable treatment options, which may include medications, physical therapy, injections, or other interventions like facet joint blocks or even facet joint nerve (medial branch nerve) ablation if the injections fail to sufficiently alleviate your back or spine pain.

How Do Facet Joint Blocks Alleviate Chronic Pain?

Facet joint blocks or injections can alleviate chronic pain through both diagnostic and therapeutic mechanisms.

The initial facet joint block serves as a diagnostic tool to identify if the facet joint is the source of your chronic pain. By injecting a local anaesthetic (+/- corticosteroid) into the facet joint or around the medial branch nerves that supply the facet joint, your physician can temporarily numb the area. If you experience significant short term pain relief following the injection, it suggests that the facet joint is likely the source of your chronic pain.

Once the facet joints are identified as the source of pain, your pain specialist can offer more targeted and effective treatment. This may include another facet joint injection with a local anaesthetic and corticosteroid (if a corticosteroid was not used initially) or radiofrequency denervation of the facet joint nerves (medial branch nerves). It ensures that subsequent therapeutic injections or treatments are directed specifically at the source of the pain, rather than a generalised approach. It also aims at providing longer term treatment for management of pain originating from the facet joints.

Therapeutic facet joint blocks serve several purposes, including: 

• Reduction of Inflammation. The corticosteroid component of the facet joint block injection helps to reduce inflammation in and around the facet joint. Inflammation is a common cause of chronic pain and can result from various conditions like osteoarthritis or injury.
• Pain Signal Interruption. The local anaesthetic in the injection blocks the transmission of pain signals from the facet joint to the brain. This provides immediate pain relief and can help break the cycle of chronic pain.
• Improved Function. By reducing pain and inflammation, facet joint blocks can improve mobility and function. Patients who get facet joint blocks often find it easier to perform daily activities, participate in physical therapy, and engage in exercise or rehabilitation programs.

The combination of a local anaesthetic for immediate pain relief and a corticosteroid for longer-lasting anti-inflammatory effects makes facet joint block injections effective in alleviating chronic pain.

What’s more, facet joint blocks are minimally invasive procedures that can provide significant pain relief without the need for surgery. By targeting the facet joints directly, these injections offer a localised treatment option that can avoid systemic side effects often associated with oral medications.

Overall, facet joint injections alleviate chronic pain by providing both diagnostic clarity and therapeutic relief. They help identify the source of pain and offer targeted treatment to reduce inflammation, interrupt pain signals, and improve function, thereby enhancing the overall quality of life for individuals suffering from chronic spinal pain.

Why Would You Get Facet Joint Block for Chronic Back or Neck Pain?

Facet joint blocks can be recommended for chronic pain for several reasons, primarily to diagnose and treat pain arising from the facet joints of the spine. 

Here are the main reasons why you might choose to undergo facet joint blocks or injections for chronic pain:

• Localised Pain: Chronic pain that is localised to the neck, upper back, or lower back regions and suspected to originate from the facet joints may warrant facet joint blocks.
• Failed Previous Diagnostics. When other diagnostic tests like MRI, X-rays, or CT scans are inconclusive in identifying the source of your pain, facet joint injections can provide more definitive diagnostic information. 
• Confirming Facet Joint as the Pain Source. If you experience significant pain relief after a diagnostic facet joint injection, it confirms that the facet joint is likely the source of your chronic pain.
• Chronic Pain Management. Facet joint injections can provide both immediate and prolonged pain relief by delivering a combination of local anaesthetic and corticosteroid medications directly to the facet joint or the nerves supplying it.
• Reducing Inflammation. The corticosteroid component helps reduce inflammation in the facet joint, which is a common cause of chronic pain.
• Enhancing Mobility. By reducing pain and inflammation, facet joint blocks can improve mobility and function, allowing you to perform daily activities more comfortably.
• Facilitating Physical Therapy. Pain relief from facet joint blocks can make it easier for you to participate in physical therapy and rehabilitation programs, further improving function and quality of life.
• Avoiding Surgery. Facet joint blocks  are minimally invasive procedures that can provide an alternative to surgery for managing chronic spinal pain.
• Reducing Need for Medications. By providing targeted pain relief, facet joint blocks can reduce the need for oral pain medications, thereby minimising potential side effects and dependency issues.
• Integrated Treatment Plan. Facet joint injections are often part of a comprehensive or multidisciplinary pain management plan that may include physical therapy, medications, lifestyle modifications, and other interventions.
• Customised Care. Tailoring treatment to your specific needs and response to facet joint blocks ensures a more personalised and effective pain management approach.

Facet joint blocks can be beneficial if you are experiencing chronic spinal pain, especially when the pain is suspected to originate from the facet joints. 

Whether used for diagnostic purposes to identify the pain source or therapeutic purposes to alleviate pain and improve function, facet joint injections offer a minimally invasive and targeted approach to managing chronic pain. 

However, it’s essential to consult with a pain management doctor to determine if facet joint injections are appropriate for your specific condition and to discuss the potential benefits and risks.

The Risks of Facet Joint Blocks or Injections

Facet joint blocks are generally considered safe procedures when performed by experienced pain management specialists. 

However, like any medical procedure, there are potential risks and complications associated with facet joint blocks, and it is essential to discuss these risks with your doctor before undergoing the procedure. 

Here are some of the potential risks and complications:

• Injection Site Reactions. Some patients may experience temporary pain, discomfort, or bruising at the injection site.
• Flare up of pain. There may be a temporary flare up of pain which is usually a ‘pressure effect’ from the injection.
• Infection.  Any invasive procedure carries a risk of infection. Though rare, infection can occur at the injection site or in the surrounding tissues, leading to complications that may require further treatment. Signs of infection include increased pain, swelling, redness, or drainage from the injection site.
• Bleeding. There is a risk of bleeding at the injection site, especially for patients taking blood-thinning medications. This can lead to hematoma (collection of blood) at the injection site.
• Allergic Reactions. Allergic reactions to the medications used in the injection, such as local anaesthetics or corticosteroids, are possible but uncommon. If a contrast dye is used during the procedure, there’s a slight risk of an allergic reaction to the dye, which may include rash, itching, or more severe reactions like anaphylaxis.
• Nerve Damage. Although rare, there’s a risk of nerve damage due to needle placement (direct trauma), the medication injected, infection or bleeding. Symptoms may include numbness, tingling, weakness, or increased pain. Some patients may experience temporary nerve irritation or exacerbation of pain following the injection, which usually resolves on its own.
• Spinal Cord or Nerve Root Injury. Although extremely rare, there’s a risk of injury to the spinal cord or nerve roots during the injection, which can lead to neurological deficits, bowel and bladder dysfunction, numbness and paralysis. 
• Steroid related side effects. Corticosteroids used in the injection can temporarily increase blood sugar levels in patients with diabetes. There may be transient flushing, mood swings and insomnia on the day of the procedure. 
• Facet Joint Injury. In rare cases, the facet joint or surrounding structures may be injured during the injection, potentially leading to increased pain or complications.
• Exposure to X-Rays and CT. Minimal doses of radiation are used to reduce the lifetime risk of long-term complications (such as cancer) due to exposure to X-ray and/ or CT scanning.
• Failure. The procedure may not provide the expected result or benefit.

Your doctor will assess your individual risk factors, discuss the potential risks with you, and take precautions to minimise these risks.

It’s essential to follow all pre-procedure and post-procedure instructions provided by your doctor and inform them immediately if you experience any unusual symptoms or complications following the injection. Regular communication is key to ensuring a safe and effective facet joint block procedure.

The Process of Getting Facet Joint Blocks

Getting facet joint blocks involves several steps, from consultation with a healthcare provider to the actual injection procedure. 

Here’s a detailed description of the process:

1. Consultation. Initially, you’ll meet with a doctor, typically a pain management specialist, to discuss your symptoms, medical history, and previous treatments. A physical examination and diagnostic tests, such as X-rays, MRI, or CT scans, may be performed to identify the source of your pain and determine if facet joint blocks are appropriate for you.
2. Informed Consent. Before the procedure, your doctor will explain the benefits, risks, and potential complications of facet joint injections. You’ll have the opportunity to ask questions and provide written consent to undergo the procedure.
3. Preparation. You may be instructed to stop taking certain medications, especially blood thinners, a few days before the procedure to reduce the risk of bleeding. The procedure is generally performed under CT guidance and you will be asked to attend a specific radiology clinic where there is access to a CT scanner. Your pain management doctor will then perform the procedure under local anaesthesia at the CT clinic. You will be requested not to drive on the day and be accompanied by a family member or friend who can take you home on the day.
4. During the Procedure. You’ll be asked to lie face down on a CT table. The injection site, usually the lower back or neck, will be cleaned and sterilised. A local anaesthetic will be applied to numb the skin and underlying tissue at the injection site. This may cause a brief stinging or burning sensation.
5. CT Guidance. Using the CT scanner, which provides real-time CT guidance, your doctor will guide a thin needle towards the facet joint or the medial branch nerves that supply the joint. A contrast dye might be injected to confirm the needle’s accurate positioning within the facet joint or near the medial branch nerves.
6. Injection. Once the needle is correctly positioned, the medication, which usually consists of a local anaesthetic and a corticosteroid, will be injected into the facet joint or around the medial branch nerves.
7. Post-Injection Observation. After the injection, you’ll be monitored for a short period to ensure there are no immediate adverse reactions, such as allergic reactions or excessive bleeding. You will be provided with a Pain Chart to log your pain over the following two weeks to assess for the efficacy of the Facet joint block.

Getting facet joint blocks involves thorough consultation and preparation prior to getting the actual injection procedure with fluoroscopic guidance. In addition, you should be prepared for post-procedure care and follow-up. Consult with your doctor regarding any concerns or questions you may have about facet joint blocks or the overall procedure.

Preparing for Facet Joint Blocks

Preparing for a facet joint block at the Persistent Pain Solutions clinic will require close communication with Dr Mittal and her team. 

Be sure to disclose all medications you may be taking and note that you may have to discontinue some or all of them immediately prior to the procedure.

Prior to your appointment, please inform us if:

• You are currently taking antibiotics.
• You have a pacemaker or defibrillator.
• You have any allergies.
• You have diabetes.
• You are taking any blood thinning medications.
• You are feeling unwell, as we may need to reschedule your procedure.

For your safety, we recommend arranging transportation to and from your appointment, as driving yourself is not advised within the 24-hour period following the procedure.

We generally recommend you take leave from work on the day of the procedure AND one day after the procedure, to rest and recover from the procedure. 

If you are receiving facet joint blocks, we advise you to refrain from undergoing any additional medical procedures, such as dental treatments or colonoscopies, within 48 hours before or after receiving a facet joint block. 

Dr Meena Mittal and her team will provide specific guidance tailored to your situation. It’s important to adhere to your instructions diligently. If you have any concerns or queries, don’t hesitate to ask—we’re here to support you throughout the process.

After Getting Facet Joint Blocks (Follow-Up)

Following your facet joint block procedure, you are free to return home. 

There are no specific restrictions on your day-to-day activities. However, it’s advisable to prioritise rest and engage in gentle activities during the initial 24 hours after your procedure.

Occasionally, you may experience some discomfort or bruising at the injection sites. Occasionally there is a temporary flare up of the pain.

You may commence physiotherapy one week after the procedure. You may return to hydrotherapy or a swimming pool/ spa two weeks after the procedure. 

We do not recommend any long distance or overseas travel for at least two weeks after the procedure. This is such that any issues or complications can be monitored and addressed in a timely manner. 

A follow-up appointment will be scheduled at 2 weeks post procedure to assess your response to the facet joint block. You will be requested to bring the post procedure Pain Chart such that the results can be analysed by Dr Mittal and next steps in your treatment plan can be discussed with you. 

After obtaining a diagnostic facet joint block, a positive test block is considered if there is a significant reduction in pain over the first 4-6 hours after the procedure. Once the local anaesthetic wears off, it is normal for pain to increase to its pre-procedure levels. 

If the pain is not originating from the facet joints, there will be no change to the levels of pain after the facet joint block. This would be considered as a negative diagnostic block. 

After obtaining a therapeutic facet joint block, the steroid medication may take effect within a few days or sometimes within 1-2 weeks after the procedure. The expected pain relief is anywhere between 50-80% reduction in pain levels.  

The effectiveness of a facet joint block can last anywhere from one to six months following the procedure. Please feel free to reach out to us with any questions or concerns during your recovery period. 

How Long Does a Facet Joint Block Last?

The pain relief from getting a facet joint block varies based on your individual situation and depends on your particular condition, the intensity of your pain, and your response to the injection. In general, the effects of a facet joint block can last anywhere from several weeks to several months or even years. 

In many cases, you may experience some immediate initial pain relief that lasts for several hours due to the local anaesthetic in the injections. However, the full benefit of a therapeutic facet joint block is provided by the steroid medications in the injection and that may take a few days (up to 1-2 weeks) to become apparent. Once that has kicked in, you should feel some pain relief and improved functionality in your back and spine.

It’s important to note that while a facet joint block can often alleviate your back pain in the short term, these types of blocks are often part of a comprehensive treatment plan that may include physical therapy, medications, and other interventions. 

Repeat facet joint blocks may be necessary for long-term management of chronic spine and back pain, depending on the underlying condition and your personal response to the injections.

Ultimately, the length of time that the pain relief from a facet joint block should be discussed with your pain management doctor. Dr Mittal and her team can provide personalised guidance based on your specific circumstances, health concerns, and pain levels. 

If facet joint blocks do not provide adequate long-lasting relief for your back or spine pain, then facet joint nerve ablation or radiofrequency ablation may be recommended. This is a minimally invasive procedure that uses heat to disable the nerves responsible for transmitting pain signals from the facet joints. This treatment aims to provide long-lasting relief from chronic back or neck pain associated with facet joint arthritis or injury.

Finding a Doctor Who Performs Facet Joint Blocks Near You

If you are suffering from chronic spinal or back pain due to major injury or trauma, post-surgical complications, strain from overuse or poor posture, or spinal conditions like spinal stenosis, spondylolisthesis, ankylosing spondylitis, or herniated discs, then facet joint blocks may be a good solution.

Ask your general practitioner for a referral to a pain management physician who offers facet joint blocks or injections or similar procedures for back, neck and spinal pain.

You can also look up pain management clinics online or speak to family members, friends, or support groups (both online and in real life) for recommendations from those who have dealt with similar painful spine problems.

Facet Joint Blocks at Persistent Pain Solutions

Persistent Pain Solutions provides facet joint blocks or injections. This technique is a procedure designed to alleviate spine and back pain stemming from conditions like major injury or trauma, post-surgical complications, strain from overuse, problems from poor posture, or spinal conditions like spinal stenosis, spondylolisthesis, ankylosing spondylitis, or herniated discs.

Facet joint blocks can alleviate some lower back, upper back and neck pain and enable you to effectively engage in rehabilitation and physical therapy, leading to longer-term relief and a more comfortable daily routine.