Treatment information
Understanding your pathway
What is the treatment?
Facet joints connect adjacent vertebrae and help guide spinal movement. A facet joint injection places medication into or around a selected joint, usually with a local anaesthetic and sometimes corticosteroid. This differs from a medial branch block, which targets the nerve supply rather than the joint space. [1][2][3]
Who may be considered?
Selection requires a clear rationale after assessment of spinal pain and previous care. Arthritis seen on imaging does not establish that a facet joint is painful. In particular, intra-articular spinal injections are not routine treatment for nonspecific low back pain. Discuss why this option is being considered instead of alternatives. [1][2][3]
Assessment, preparation and consent
Before deciding, discuss your diagnosis, previous treatment, medicines and relevant health conditions. Tell the clinician about allergies, infection, blood-thinning medicines, diabetes and possible pregnancy. Do not stop prescribed medicines yourself. Ask what alternatives are available, including not having a procedure, and allow time to consider the benefits, uncertainty and risks that matter to you. [4]
What happens during treatment?
The clinician identifies the target joint and uses imaging where appropriate to guide needle placement. Medication and any contrast are chosen for the planned purpose. Positioning, local anaesthetic and monitoring vary with the spinal region and your health. A treatment plan should specify the joint and intended outcome. [1][2][3]
Risks and safety considerations
Risks include pain flare, bleeding, infection, allergy and injury to nearby structures. Steroid can cause flushing, skin changes or a temporary rise in blood glucose. Spinal level and the chosen technique influence additional risks. Imaging improves visual guidance but cannot guarantee an uncomplicated or effective procedure. [1][2][3]
Recovery and when to seek help
Follow the written instructions for transport, supervision, medicines, activity and driving. Recovery depends on the treatment and your health, so a fixed return-to-work date cannot be promised. Ask who to contact outside clinic hours. Seek urgent assessment for fever with worsening pain, new weakness or other unexpected neurological symptoms. Call 000 for breathing difficulty, collapse or another medical emergency. [5][4]
Expected benefit and limitations
Benefit is uncertain and may be short-lived. The procedure does not reverse arthritis or replace active rehabilitation. If the purpose is diagnostic, agree how the result will be interpreted. A medial branch block or no injection may be more appropriate depending on the clinical question and available evidence. [1][2][3]
Follow-up and rehabilitation
Before treatment, choose a practical goal such as walking, sleep or a daily task. Record changes in that activity, pain and any adverse effects, then discuss them at follow-up. Ask what degree of change would justify further treatment and what would lead to stopping or changing the plan. Rehabilitation and self-management may remain part of care even if symptoms improve. [4][6]
Questions to bring to your appointment
Ask which structure is being targeted, why this approach is being considered and how strong the evidence is for your diagnosis. Clarify costs, the planned review date and any practical help you may need at home. Bring previous reports and your medicine list so the discussion can address your circumstances rather than a generic treatment pathway.
Sources and further reading
Sources support the statements cited above. Overseas guidance may describe different services or eligibility rules. A procedure leaflet explains a technique and its risks; it does not establish that the treatment is effective for every condition.
- Facet joint injections and medial branch block — The Dudley Group NHS Foundation Trust
- Consensus guidelines on interventions for lumbar facet pain — Regional Anesthesia and Pain Medicine
- Low back pain and sciatica: recommendations — NICE
- Procedures in pain medicine clinical care standard — Faculty of Pain Medicine, ANZCA
- Dorsal root ganglion / nerve root block / transforaminal injection — Hull University Teaching Hospitals NHS Trust
- Options for chronic pain management — Healthdirect Australia