Facet Joint / Nerve Injections
The actual injection takes only a few minutes, but plan to spend 1-1.5 hours at the facility.
The injection consists of a mixture of local anesthetic (lidocaine) and steroid medication (preservative-free triamcinolone).
The procedure involves inserting a needle through the skin and deeper tissues. There is some discomfort involved, and to minimize that we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the facet block needle. IV sedation is used in most cases to provide relaxation, but you will not be “put out” for the procedure. If you undergo IV sedation you will have food and water restrictions (see the last page “REMEMBER”)
It is done with the patient lying on the stomach or on your side, under x-ray control. The patients are monitored with a blood pressure cuff and blood oxygen-monitoring device, in most cases under monitored anesthetic care.
Immediately after the injection, you may feel some soreness. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a “sore back” for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. The cortisone starts working in about 1 to 5 days and its effect can last for several days, months, or even years.
Please make an appointment to see us for a follow-up 2-3 weeks after each injection, to consider future treatment options. You should have a ride home. Please DO NOT plan to drive or use machinery at work the day of the procedure. You do not need to stay in bed. You may walk and perform usual activities as tolerated, but do not resume strenuous physical activity even if you feel better. Discuss with a doctor or physical therapist at our practice.
If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection or a nerve block. For longer-lasting pain relief Facet denervation therapy using Radiofrequency energy can be indicated. Ask your doctor if you are a candidate for these specialized treatments.
In most cases, it will not stop all back or neck pain. In most cases, it may reduce pain by 50% or more than before. Some patients may feel more relief from an injection than others, while some patients may need more than one injection or nerve block to consider future longer-lasting therapies. Facet denervation uses radiofrequency heatwave energy to temporarily interrupt or zap nerve endings that carry pain signals arising from the facet joint. These nerves are called medial branches.
Generally speaking, this procedure is safe. However, with any procedure, there are risks, side effects, and the possibility of complications. The most common side effect is pain – which is temporary. The other rare risks may include infection, bleeding, spinal puncture with headaches, nerve injury, etc.
WHO SHOULD NOT HAVE THIS INJECTION?
If you are allergic to any of the medications to be injected, or if you have an active infection or illness, you should not have the injection.
CERTAIN MEDICATIONS MAY INCREASE THE RISK OF COMPLICATIONS. * If you are on Coumadin (warfarin), Heparin, Aggrenox, Lovenox (enoxaparin), Ticlid
If you are taking Coumadin or Plavix (or related products) you should have stopped it 7 days prior to this procedure.
(ticlopidine), Plavix (clopidogrel), Pradaxa (dabigatran), Eliquis (apixaban), Xarelto (rivaroxaban), OR any other BLOOD THINNING products you will need to get a medical clearance allowing you to stop your medication from your primary physician or cardiologist, prior to your scheduled procedure. DO NOT STOP TAKING YOUR MEDICATIONS UNTIL WE CALL AND NOTIFY YOU THAT YOU HAVE A MEDICAL CLEARANCE. You can continue to use Celebrex and your pain medicines before the procedure. You should continue to TAKE YOUR ROUTINE MEDICATIONS. If you are on antibiotics please notify us.
Remember:
- Please DO NOT stop taking your blood pressure, diabetes, insulin, or cardiac medicines days prior to the procedure.
- Have an adult drive and be there on your discharge after the procedure.
- Wear loose, comfortable 2 piece clothing. Please do not bring any valuables inside the procedure area as you undergo anesthesia. If you are diabetic, steroids may temporarily affect your blood sugar. If you are fasting for IV sedation/anesthesia-related to the procedure, you may miss the morning dose of your diabetic medicine, check with your medical doctor.
- Stop taking Coumadin or Plavix (related products) 7 days prior to the scheduled procedure as directed by your medical doctor.
- Bring any requested MRI, CT, X-ray images on the day of the procedure.
- If you are pregnant or if there a possibility that you may be pregnant, let the physician know immediately, as the X-ray camera cannot be used.
- When you check in, you will need to sign consent forms, advise the medical staff of any allergies, especially to shellfish, iodine, contrast dyes, or Latex.
- IV sedation; No FOOD for 8 HOURS before the procedure. Clear fluids (Water, Apple Juice) are OK 4-6 hours before the procedure. If you are Diabetic and have taken your medicines, please make sure you drink Apple Juice 4-6 hours before your procedure.
FACET JOINT/ NERVE INJECTIONS
WHAT IS A FACET JOINT INJECTION & WHEN IS IT INDICATED?
Facet Joint Injection is an injection of long-lasting steroid (“cortisone”) and/or local anesthetic in the joints or nerves that input the joints done under a fluoroscope (X-ray camera) with the latest and advanced techniques. These injections are performed in patients that suffer from unremitting back or neck pain that has not responded to other less invasive non-surgical options such as physical therapy, oral medications, etc.
WHAT IS THE PURPOSE OF IT?
The facet joints are a source of pain when they become arthritic and/or inflamed, a steroid injection reduces the inflammation and/or swelling of tissue in the joint space. It can be compared to “putting the fire out from where it starts”. This may in turn reduce pain and other symptoms.
