Persistent neck or back pain can sometimes come from the small facet joints that help guide movement between the vertebrae. When one or more of these joints become irritated, inflamed, or arthritic, a facet joint injection may be considered as part of the diagnostic and treatment process.
A facet joint injection places medication directly into the suspected joint using image guidance. Depending on the clinical goal, the injection may help determine whether the facet joint is contributing to your symptoms and may also provide temporary relief by reducing inflammation.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, examination findings, imaging, and treatment history to determine whether a facet joint injection, medial branch block, or another treatment may be appropriate.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is a Facet Joint Injection?
A facet joint injection is an image-guided procedure in which medication is placed directly into a facet joint of the spine.
Facet joints are small paired joints located along the back of the spinal column. They help guide movement and provide stability as you bend, twist, and extend your neck or back. Like other joints in the body, they can develop arthritis, inflammation, or degenerative changes.
During a facet joint injection, a small amount of medication is placed into the suspected joint. Depending on the purpose of the procedure, the medication may include a local anesthetic, a corticosteroid, or both.
The immediate response to local anesthetic can provide information about whether the injected joint is contributing to your pain. When corticosteroid is used, the goal is to reduce inflammation and potentially provide temporary symptom relief.
A facet joint injection does not reverse arthritis or permanently repair degenerative changes. The procedure is used as part of a broader evaluation and treatment plan based on the suspected source of your symptoms.
Who May Be a Candidate for a Facet Joint Injection?
Your pain management provider may consider a facet joint injection when your symptoms and examination suggest that one or more facet joints could be contributing to your pain.
You may be evaluated for a facet joint injection if you have:
- Persistent neck, mid-back, or low back pain that may be coming from the facet joints
- Pain that worsens with extension, rotation, prolonged standing, or certain movements
- Localized tenderness near the spine
- Facet arthritis or degenerative facet changes that may correspond with your symptoms
- Symptoms that have not improved enough with conservative treatment
- A clinical examination that raises concern for facet-mediated pain
Facet joint injections are not appropriate for every type of neck or back pain. Pain caused primarily by an irritated spinal nerve, disc herniation, spinal stenosis, muscle strain, or another source may require a different treatment approach.
Your provider will review your symptoms, examination findings, imaging, medications, previous treatments, and treatment goals before recommending an injection.
What Conditions Can Facet Joint Injections Help Evaluate or Treat?
Facet joint injections are most commonly considered when pain appears to originate from the facet joints rather than from a spinal nerve or another structure.
Conditions and pain patterns that may lead to a facet joint injection include:
Facet Joint Pain
Facet joints can become irritated or inflamed and contribute to localized neck, mid-back, or low back pain. An injection may help determine whether a particular joint is involved and may provide temporary relief.
Facet Arthritis and Spondylosis
Arthritic and degenerative changes can affect the facet joints over time. Because these changes can appear on imaging even in people without symptoms, your physician considers the imaging together with your pain pattern and examination findings.
Chronic Neck Pain
Some cases of chronic neck pain may arise from cervical facet joints. Cervical facet injections may be considered when the clinical evaluation points to those joints as a potential pain source.
Chronic Low Back Pain
Some cases of chronic low back pain may arise from lumbar facet joints. A lumbar facet injection may be considered when symptoms and examination findings are consistent with facet-mediated pain.
Because spinal pain can also come from discs, nerves, muscles, sacroiliac joints, and other structures, identifying the likely pain generator is an important part of selecting the right procedure.
Facet Joint Injection vs. Medial Branch Block
Facet joint injections and medial branch blocks are related procedures, but they target different structures.
A facet joint injection places medication directly into the joint itself. Depending on the clinical goal, it may be used to help evaluate the joint as a pain source and may also be used therapeutically to reduce inflammation.
A medial branch block places local anesthetic near the small medial branch nerves that carry pain signals from the facet joints. It is commonly used as a diagnostic step when your physician is considering radiofrequency ablation.
The procedure that is most appropriate depends on the purpose of the evaluation, your symptoms, previous treatment, examination findings, and applicable clinical or insurance requirements.
Types of Facet Joint Injections
Facet joints are located throughout the cervical, thoracic, and lumbar spine. The treatment area depends on where your symptoms are located and which joints your physician believes may be contributing to the pain.
Cervical Facet Joint Injection
Cervical facet injections target joints in the neck. They may be considered when a cervical facet joint is suspected of contributing to chronic neck pain or referred discomfort around the upper back or shoulders.
Thoracic Facet Joint Injection
Thoracic facet injections target joints in the mid-back. They may be considered in selected patients when the clinical evaluation suggests that thoracic facet joints are contributing to localized mid-back pain.
Lumbar Facet Joint Injection
Lumbar facet injections target joints in the lower back. They may be considered when lumbar facet joints are suspected of contributing to chronic axial low back pain.
The exact level, side, and number of joints treated depend on your symptoms, examination, imaging, and treatment plan.
How Does a Facet Joint Injection Work?
Before the procedure begins, you will be positioned so your physician can safely access the appropriate area of the spine. The skin is cleaned, and local anesthetic is used to numb the injection site.
Your physician uses fluoroscopy, a form of real-time X-ray guidance, to guide a thin needle into the targeted facet joint. Contrast material may be used when appropriate to help confirm needle placement.
Medication is then injected into the joint. The medication used depends on the purpose of the procedure and may include a local anesthetic, a corticosteroid, or both.
After the injection, the needle is removed and you are monitored before discharge. If the procedure is being used diagnostically, your physician may ask you to track changes in your pain and ability to perform activities that normally trigger symptoms.
The injection itself is generally brief, although your total visit will be longer because of preparation, positioning, monitoring, and discharge instructions.
What to Expect Before, During, and After a Facet Joint Injection
Before the Procedure
Your care team will provide instructions based on your health history and the specific procedure being performed.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have diabetes
- Have an active infection, fever, or illness
- Have allergies to medications, contrast material, or other substances
- Are pregnant or may be pregnant
- Have experienced a previous reaction to an injection or corticosteroid medication
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow any instructions provided by the office regarding eating, drinking, medications, and transportation. If you are preparing for an upcoming visit, our patient forms are available online.
During the Procedure
You may feel a brief pinch or burning sensation when local anesthetic is administered. During needle positioning or injection, some patients notice pressure or temporary discomfort.
Fluoroscopic imaging allows the physician to view the relevant spinal anatomy while guiding the needle into the facet joint.
If you experience intense or unusual symptoms during the procedure, tell your physician immediately.
After the Procedure
Some soreness, tenderness, or bruising around the injection site is common. Your usual pain may also temporarily increase before any anti-inflammatory effect develops.
If local anesthetic is used, you may notice temporary improvement soon after the injection. This early response is different from the potential effect of corticosteroid medication, which can take longer to develop.
Your care team will provide specific instructions regarding driving, medications, activity, and when you can return to exercise or your usual routine. Contact the office if you develop symptoms that concern you after the procedure.
Risks, Side Effects, and Safety Considerations
Facet joint injections are commonly performed in interventional pain management, but every injection procedure involves potential risks and side effects.
Temporary effects may include:
- Soreness or bruising at the injection site
- A temporary increase in pain
- Temporary numbness or weakness
- Dizziness or lightheadedness
- Flushing or temporary blood sugar changes when corticosteroid is used
Less common complications can include:
- Bleeding
- Infection
- Allergic or medication-related reactions
- Unintended injection into a blood vessel
- Nerve irritation or injury
- Other injury to a nearby structure
The potential risks depend on the treatment location, your anatomy, medications, allergies, medical conditions, and the medications used during the procedure.
Your physician will review the potential benefits, limitations, alternatives, and risks that are relevant to your individual situation before recommending the injection.
How Soon Can a Facet Joint Injection Start Working?
Results vary from patient to patient and depend partly on the medications used.
If local anesthetic is included, you may notice a temporary change in pain relatively soon after the injection. When the procedure is being used diagnostically, this early response can help your physician evaluate whether the injected joint is contributing to your symptoms.
If corticosteroid is used, any anti-inflammatory effect generally takes longer to develop. Some patients notice improvement within several days, while others may take longer.
It is also possible for symptoms to temporarily increase before improving. A facet joint injection does not provide meaningful relief for every patient.
How Long Can Relief From a Facet Joint Injection Last?
The duration of relief after a facet joint injection varies considerably.
Some patients experience improvement for several weeks or months, while others experience shorter relief or little change in their symptoms. The response may depend on factors such as:
- Whether the facet joint is actually the primary pain source
- The degree of inflammation or arthritis
- The spinal level treated
- The medications used
- Your overall health and activity level
- Your response to previous treatment
A facet joint injection does not permanently cure arthritis or degenerative changes. Temporary symptom reduction may help some patients participate more comfortably in rehabilitation, exercise, work, or everyday activities.
Can Facet Joint Injections Be Repeated?
Repeat facet joint injections are not automatically appropriate for every patient.
Your provider may consider another injection based on factors such as the amount and duration of relief, improvement in function, diagnosis, medications used, overall health, and the broader treatment plan.
If an injection does not provide the expected benefit, your provider may recommend reassessing the source of your pain rather than simply repeating the same procedure.
In some cases, the next diagnostic step may be a medial branch block. If diagnostic blocks support facet-mediated pain, radiofrequency ablation may be considered as a longer-lasting treatment option.
Insurance plans may also have specific requirements regarding repeat injections and related procedures.
What Happens If a Facet Joint Injection Does Not Work?
Not responding to a facet joint injection does not mean that there are no other treatment options.
If you do not experience meaningful improvement, your provider may reconsider whether the injected facet joint is the primary source of your symptoms and review your examination findings, imaging, and response to previous treatment.
Depending on your condition, the next step could include:
- Physical therapy or rehabilitation
- Changes to medications
- Additional diagnostic testing or imaging review
- A diagnostic medial branch block
- Radiofrequency ablation when diagnostic testing supports facet-mediated pain
- An epidural steroid injection if spinal nerve irritation is suspected instead
- Evaluation of discs, sacroiliac joints, muscles, or other possible pain generators
- Other interventional pain management options
- Referral for surgical evaluation when clinically appropriate
The goal is to identify the structure most likely responsible for your symptoms and adjust treatment based on that diagnosis rather than relying on one procedure for every type of spinal pain.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to facet joint injections includes:
- Individualized evaluation before recommending a procedure
- Fluoroscopic image guidance
- Treatment based on the suspected source of pain
- Careful review of your response after the injection
- Coordination with medial branch blocks and radiofrequency ablation when appropriate
- Access to additional pain management options when the facet joints are not the likely pain source
- Care focused on function and quality of life rather than promising a specific outcome
Facet Joint Injection Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers facet joint injection evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Facet Joint Injections
A facet joint injection is an image-guided procedure that places medication directly into a facet joint of the spine. Depending on the purpose of the procedure, it may help evaluate whether the joint is a source of pain and may also provide temporary relief by reducing inflammation.
Facet joint injections may be considered when cervical, thoracic, or lumbar facet joint pain is suspected, including pain associated with facet arthritis or degenerative changes. Your provider will determine whether your symptoms and examination findings make the facet joints a likely pain source.
No. A facet joint injection places medication into the joint itself. A medial branch block places local anesthetic near the small nerves that carry pain signals from the facet joint and is commonly used before radiofrequency ablation.
Local anesthetic is used to numb the treatment area, but you may still notice a brief pinch, pressure, or temporary discomfort during needle positioning and injection. Experiences vary, and you should tell your physician about intense or unusual symptoms.
The injection itself is generally brief. Your total appointment will take longer because of preparation, positioning, image guidance, the procedure, monitoring, and discharge instructions.
If local anesthetic is used, you may notice a temporary change in pain relatively soon after the procedure. If corticosteroid is included, any anti-inflammatory effect may take several days or longer to become noticeable.
Relief varies considerably. Some patients experience improvement for several weeks or months, while others have shorter relief or little change. The response depends on the underlying condition, the medications used, and whether the treated joint is actually the primary pain source.
Repeat injections may be considered depending on the amount and duration of relief, improvement in function, diagnosis, medications used, overall health, and insurance requirements. They are not automatically scheduled as a predetermined series.
Potential effects include temporary soreness, bruising, increased pain, numbness, weakness, dizziness, or medication-related effects. Less common complications include bleeding, infection, allergic reactions, unintended injection into a blood vessel, nerve injury, or injury to a nearby structure.
Some soreness or tenderness is common. Follow the activity, driving, medication, and recovery instructions provided by your care team. If the injection is being used diagnostically, you may also be asked to track changes in your usual pain.
Your provider may reassess the likely source of your pain and consider other options such as a medial branch block, radiofrequency ablation when diagnostic criteria are met, an epidural injection if nerve irritation is suspected, rehabilitation, medication changes, or evaluation of another pain generator.
Regenerative Spine and Pain Specialists offers facet joint injection evaluation and treatment at our Fayetteville, Marietta, and Atlanta, Georgia locations. Our scheduling team will confirm the appropriate location for your evaluation and procedure.
Schedule an Appointment for a Facet Joint Injection Evaluation
Persistent neck or back pain can interfere with work, sleep, exercise, and everyday activities. If your symptoms may be coming from one or more facet joints, a facet joint injection may help clarify the source of pain and may also provide temporary symptom relief.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, review your previous treatment and imaging when appropriate, and help determine whether a facet joint injection, medial branch block, radiofrequency ablation, or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.