Facet joints produce pain by means of the medial branch nerves. Your arms or legs are not controlled by these nerves. Your low back, neck, and mid-back contain grooves formed by bony growths.

Facet joints seem to be the source of your pain. There is convincing evidence to support this hypothesis. You have not received adequate pain relief from simple joint injections or other treatments. So, by using a special needle, you may be able to interrupt the pain signals from the small medial branch nerves. The numbing medicine we use will first block the signals sent by the medial branch nerves as a test before we interrupt their pain signals. By doing so, we can determine if you are likely to benefit from the special radio-frequency (RF) needle to interrupt the medial branches at a later date. Medial branch neurotomy is the more permanent form of this treatment.

Medial Branch Procedure

The first step will be to start an IV to administer relaxation medication if you wish. As you lie on the x-ray table, you will clean the skin over the area that is undergoing the test. The doctor will then numb a small portion of skin with numbing medicine (anesthetic), which involves some stinging for a few seconds. The next step involves sending a very small needle through the medial branch nerves under x-ray guidance. To determine whether the medications will only apply to these medial branch nerves, he will inject several drops of contrast dye. Anaesthesia is then slowly injected slowly into a small area of the body to numb it.

The affected area will be moved approximately 20-30 minutes after the procedure to induce pain. We will provide you with a “pain diary” that you can fill out if there is any remaining pain. You will also be able to write down the relief you experience over the next six hours. Depending on whether the injected medial branch nerves carry pain signals from your spinal joints to your brain, you may or may not feel improvement in the first few hours after the injection. The complete pain diary should be returned to your treating physician as directed so he or she can follow up on the results and prepare any necessary tests and/or treatments.

Sometimes, after receiving the injection, you may feel numb or weird for a few hours. As the numbing medication wears off, you may experience a slight increase in pain for several days. In the weeks following a therapeutic injection, ice is often more effective than heat. On occasion, medication injected into these nerves can provide long-term relief even when this procedure does not evaluate the need for a medical branch neurotomy. Following the procedure, you are free to continue taking your regular medication. However, it is advisable to limit the use of pain medication for the first six hours after the procedure so that accurate diagnostic information is obtained.

You should not drive or attempt to exert yourself on the day of the injection. You are free to resume normal activities the next day. Afterward, start exercising/doing activities in moderation, if your pain has improved. Ensure that your activities are gradually increased over 1-2 weeks, even if you are significantly better.

What are the Risks and/or Side Effects?

Most injections are associated with the risk of bleeding, infection, allergic reaction, and in some cases, nerve damage due to wrong injection locations. Fortunately, these adverse reactions are rare. If the injection spreads to the surrounding area, numbness may occur as a short-term side effect of a medial branch block. Pain and tenderness might also be present at the injection site. A medial branch block can sometimes cause headaches or insomnia, but these side effects usually subside within a few days.

What are the Benefits?

Medial branch blocks provide the greatest benefit in determining what’s causing your pain and deciding the next step to take. Some people report temporary pain relief after a medial branch block.

How Do I Prepare?

A 30- to 60-minute preparation period is necessary before the injection, although you do not need a hospital stay for this procedure. The chances of you walking right after your procedure are good, but you might need additional monitoring if complications arise. Though you’ll be awake during the injection, it’s not advisable to drive after the procedure for up to 24 hours afterward.

You may be asked not to take any pain medications before the procedure, since part of the result is determining how your pain changes after the injection.

How is it Done or Administered?

In order for your doctor to reach the injection site, you’ll need to change into scrubs before the procedure. The procedure usually consists of these steps:

Observation. Your vitals will be monitored beforehand to make sure no concerns need to be discussed with your doctor.

Sedation. Typically, you’ll be given a sedative to calm anxiety and relax muscles.

The procedure is performed on an upside-down table. By doing so, the injection can be delivered more efficiently.

Anesthesia was administered locally. An unexpected feeling of stinging or burning is commonly reported during this procedure.

Injections. Since the anesthesia is numb, this only lasts for a few seconds.

Postoperative recovery. To ensure that there are no complications, you will be observed following the injection.

When Will I Know the Results?

You may experience pain relief in the short term after having a facet block injection. In spite of this, the diagnosis or testing that medial branch blocks provide will only provide temporary relief. Additional treatments may be recommended to relieve pain more permanently.

What are Follow-up Requirements and Options?

Following the procedure, the doctor may advise you not to drive for 24 hours and not to bathe or submerge yourself in water for up to two days. About two weeks after your procedure, you will typically schedule a follow-up appointment to determine what steps to take next in your treatment plan.

Facet joints connect the vertebrae in the spine, and medial nerves pass through them. These nerves send signals to the brain that are blocked by medial branch blocks. Using this test, your doctor will be able to pinpoint the source of your back pain and figure out the optimal treatment plan.