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Facet Joint Injection
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Facet joint injection
It is important that before you agree to treatment you are aware
of the potential benefits and the side effects or complications.
Please read this information all the way through.
Why has a facet joint injection been suggested?
The facet joints are part of the bony spine. A combination of
your hospital records and Pain Clinic assessment has shown that
the pain you experience involves the facet joints. You may have
noticed that when a particular area of your spine is palpated
(pressed) it is very tender. Often, turning from side to side or
bending backwards can cause you pain. The pain may also
involve other areas of your body. Injecting the facet joints with
a local anaesthetic and anti-inflammatory drug (steroid) can be
helpful.
What is a facet joint injection?
A facet joint injection is a combination of a steroid and local
anaesthetic which is injected into the facet joint and the
surrounding area. In order to ensure the injection is being
performed in the correct place, the procedure is performed
under X-ray control. The area around the facet joint may also
be injected so that the nerves that supply that joint can be
numbed which could also help to relieve your pain.
Can anyone have a facet joint injection?
Most people can have a facet joint injection. However, if you
are female and below the age of 55 you will be asked about
the date of your period. If it was more than 28 days ago you
will be asked whether you are likely to be pregnant. Although
the amount of radiation used is small, there is always a risk
to the foetus. Occasionally we may need to ask you to have a
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pregnancy test.
If you have any localised infection, such as a boil on your
back or a generalised infection, the procedure would not be
performed until the infection has cleared up.
How effective is the treatment?
For many people these injections result in noticeable
improvements in symptoms but they don’t work for everybody.
Unfortunately this cannot be predicted. The effects can last
for weeks, months or even years. Injections may be repeated if
symptoms return.
The risks associated with facet joint injections
are small
A local anaesthetic agent is injected into the joint. The dose
is below the maximum recommended dose. If you require a
number of injections, we would inject a safe amount in one visit
and perhaps arrange for you to return to have more injections
(if required) at a later date.
High doses of steroid (anti-inflammatory drugs) can cause
health problems but we restrict the amount used ensuring that
the dose is well within safe limits.
There is a small risk of blocking the nerves that leave the
spine behind the facets within the lumbar area. These nerves
transmit messages (including pain and sensation) to the legs.
An injection into these nerves can cause temporary weakness,
however, this is infrequent.
All risks associated with the procedure will be discussed with
you by your pain consultant prior to your procedure.
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What is the procedure for the injection?
A cervical facet joint injection is an injection into your neck
(cervical spine). You will be admitted to Ambulatory Care (day
ward). Once admitted you will be escorted to the theatre where
the procedure will be performed. It is a normal precaution
to insert a small tube into a vein in your arm which will be
removed after the procedure. Once inside the theatre you
will be asked to lie face-up with your head gently extended
over a pillow. Following the procedure you will be taken to
the recovery area where you will be monitored before being
transferred back to Ambulatory Care.
All other facet joint injections are performed with the patient
lying face-down on the imaging table. The doctor will be
guided by the X-ray machine to check the position of the
needle before administering the medication.
When the injection is being given, the doctor may ask if the
pain is in the same place as the pain you normally feel. If it is,
this is a good sign that the injection is in the right place.
Can I have sedation?
Sedation means using a drug to make you sleep during the
procedure. We prefer not to use sedation for two reasons:
1. Sedation means that it will take longer for you to recover and
you will require close observation for a longer period of time
2.You will not be able to respond to questions asked during the
procedure if sedated
Pre-procedural education
You may be required to attend an education session before
undergoing your procedure. During this session you will be
advised on what to expect on the day and the potential
risks and benefits of the procedure. You will also be given
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an overview of pain management including pacing, flare-up
management and goal setting. At this session you will also have
the opportunity to ask questions.
As you are aware, these procedures are not a cure for your
pain. They are performed in order to reduce pain, maintain
or improve function and in some cases provides a window of
opportunity for people to start physiotherapy.
If you are booked onto an education session and you fail to
attend, you will not be offered the procedure as previously
planned.
Medication
Please take all your prescribed medications as normal prior to
your procedure unless you have been otherwise advised.
Please bring a list of all of your current medications when you
attend for your procedure.
Important information
Please inform the department if you have been newly
prescribed anti-coagulants (blood thinning medication), if
you have a cold or persistent cough, are taking a course of
antibiotics or there has been any significant change in your
overall health as this may affect your procedure. Failure to do so
may result in your procedure being cancelled on the day.
Can I eat before coming in?
If you are required to fast prior to your procedure, this
information will be provided with your appointment letter.
Otherwise, you can eat and drink normally before arriving in
the department.
If you are a diabetic please bring along your insulin, normal
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snacks and glucose tablets (if appropriate).
What pain might I experience after the
procedure?
The amount of pain experienced might become worse for a short
period of time. This reaction is not dangerous and should pass.
In some cases the area served by the nerve may become weak
after the injection. This effect will disappear as the local
anaesthetic wears off, usually within 4-6 hours.
What will happen after the injection?
You will be asked to remain in the clinical area for about half an
hour after the injection, during which time the nurse will check
your blood pressure and pulse along with the injection site.
When can I go home?
When advised by the nursing staff, you will be able to make
arrangements to go home.
Why can I not drive myself home?
You would not be covered by your insurance to drive a vehicle
for a period of 24 hours following your procedure. This is
because you may have a temporary weakness affecting the
injected area, which may impair your function or ability to drive
safely. Therefore, for your own well-being, we advise that you
are collected by a relative or friend.
Hospital transport can only be booked if there is a medical need
and you meet the criteria.
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Back at home
You can remove the dressing from the injection site after 24
hours. If you have any queries in relation to your care please
contact the pain service nurses on 0121 371 5105 (voicemail), or
nurse led appointment enquires on 0121 371 5110.
For general enquires or appointments please contact the
secretaries on 0121 371 5100.
Please use the space provided to write down any
questions you may have and bring it with you to your
next appointment.
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The Trust provides free monthly health talks on a
variety of medical conditions and treatments. For more
information visit www.uhb.nhs.uk/health-talks.htm or
call 0121 371 4957.
Pain Management Service
3rd Floor Nuffield House
Queen Elizabeth Hospital
Mindelsohn Way, Edgbaston
Birmingham, B15 2TH
Telephone: 0121 371 5100
PI15/0614/04 UHB/PI/0614 (Edition 4) Author: The Pain Management Team
Date: August 2015 Review date: August 2017