Facet Joint Injection Results and Follow-up

On the day a patient is to receive a facet joint injection, they are advised to avoid doing any strenuous activities, unless instructed by their physician. The patient should not drive the day of the injection unless approved by the treating physician. If sedation was used, the patient should not drive for 24 hours after the procedure. Patients may notice a slight increase in pain lasting for several days as the numbing medicine wears off and before the cortisone starts to take effect. If the area is uncomfortable in the first two to three days after the injection, carefully applying ice or a cold pack to the general area of the injection site will typically provide pain relief.

If the facet joints that were treated are the source of the pain, the patient may begin to notice pain relief starting two to five days after the injection. If no improvement occurs within ten days after the injection, then the patient is unlikely to gain any pain relief from the injection and further diagnostic tests may be needed to accurately diagnose the patient’s pain.

Patients may continue to take their regular pain medicine after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate. Patients may be referred for physical therapy or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the cortisone is working.

On the day after the procedure, patients may return to their regular activities. When the pain is improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to increase activities gradually over one to two weeks to avoid recurrence of pain.

If the facet block procedure is effective in alleviating the patient's back pain, it is often considered reasonable for the procedure to be done up to three times per year. However, if the first facet joint injection does not relieve the patient’s pain then the injection should not be repeated.

Potential risks and complications

As with all invasive medical procedures, there are potential risks and complications associated with facet joint injections. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from a facet joint injection include:

• Allergic reaction. Usually an allergy to x-ray contrast or steroid; rarely to local anesthetic.

• Bleeding. A rare complication, bleeding is more common for patients with underlying bleeding disorders.

• Infection. Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.1% to 0.01% of injections.

• Worsening of pain symptoms

• Discomfort at the point of the injection

• Nerve or spinal cord damage or paralysis. While very rare, damage can occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery causing blockage.

In addition to risks from the injection, some patients will experience side effects from the steroid medication, such as:

• Transient flushing with a feeling of warmth (‘hot flashes’) for several days

• Fluid retention, weight gain, or increased appetite

• Elevated blood pressure

• Mood swings, irritability, anxiety, insomnia

• High blood sugar—diabetic patients should inform their primary care physicians about the injection prior to their appointment

• Transient decrease in immunity

• Cataracts—a rare result of excessive and/or prolonged steroid usage

• Severe arthritis of the hips or shoulders (avascular necrosis)—a rare result of excessive and/or prolonged steroid usage

Patients who are on a blood thinning medication (such as Coumadin^®), or have an active infection, may not be able to have this procedure, and these situations should be discussed with the treating physician. Patients should also let their doctor know of any allergies they have to medications that may be used for the procedure.

• Article written By:
• Ray Baker, MD

November 12, 2004

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