Health Education Library / Pain Therapies


Facet Joint Injection

Back or neck pain may be caused by a problem with your facet joints. If so, a facet joint injection may help. With this treatment, medication is injected into certain facet joints. The injection can help your doctor find problem joints. It may also relieve your pain.

What Is a Facet Joint?

Bones called vertebrae make up your spine. Each vertebra has facets (flat surfaces) that touch where the vertebrae fit together. These form a structure called a facet joint on each side of the vertebrae.

What Is a Facet Joint Injection?

One or more facet joints in your back or neck can become inflamed (swollen and irritated). This may cause pain. During a facet joint injection, medication is injected into the inflamed joints. This treatment helps reduce inflammation and relieve pain. Pain relief should last for weeks to months. If the pain returns, you may need a repeat injection.

Getting Ready

To get ready for your treatment, do the following: At least a week before treatment, tell your doctor what medications you take (including aspirin). Ask whether you should stop taking any of them before treatment. Tell your doctor if you are pregnant or allergic to any medications. Stop eating or drinking 8 hours before you check in for your injection. If asked, bring x-rays, MRIs, or other tests with you on the day of your treatment.

During the Procedure

To help you relax, medication may be given through an IV (intravenous) line. You will lie on an exam table on your stomach, back, or side. This depends on where you will be injected. During your treatment: The skin over the injection site is cleaned. A local anesthetic (pain medication) numbs the skin. Fluoroscopy (x-ray imaging) may be used to help the doctor see your spine. If so, a contrast "dye" may be injected into the affected area. The injection is given. It may contain including a local anesthetic to numb the region around the joint or steroids (medications that reduce inflammation).

After the Procedure

Most often, you can go home in about an hour. Have an adult friend or relative drive you. The anesthetic wears off in a few hours. When it does, your back or neck may feel more sore than usual. This is normal. Take it easy for the rest of the day. The steroids most often begin to work in about 3-4 days. Your doctor can tell you when it's okay to go back to work.


Cervical Epidural Injection

For certain types of neck pain, your doctor may suggest a cervical epidural injection. With this medication is injected into your neck near your spine. The injection helps the doctor find the source of your pain. It can also help relieve your pain and soreness.

The Cervical Vertebrae

The cervical vertebrae are the bones that support your neck and head. They form the top part of your spine. The tunnel made by these vertebrae is called the spinal canal. The spinal cord runs through the spinal canal, inside a sac called the dura. Nerves branch off the spinal cord and exit through the vertebrae. Pressure on one of these nerves may cause it to become inflamed (irritated and swollen). An inflamed nerve in your neck may cause neck pain that may also be felt in your head or arms.

The Cervical Epidural Injection

To help relieve your pain, medication is injected into the epidural space. This space surrounds the dura within the spinal canal. Your doctor may also do a nerve block. During this procedure, medication is injected near a specific nerve root (the part of the nerve that leaves the spinal canal). A nerve block can help your doctor find out which nerve or nerves are the source of your pain.

Getting Ready

The injection is done in a hospital or surgery center. You'll be asked to fill out some forms, including a consent form. You may also be examined. You may be given an IV (intravenous) line for fluids and medications. At least a week before treatment, tell your doctor what medications you take (including aspirin). Ask whether you should stop taking any of them before treatment. Tell your doctor if you are pregnant or allergic to any medications. Stop eating or drinking 8 hours before you check in for your injection. If asked, bring x-rays, MRIs, or other tests with you to your treatment.

During the Procedure

To help you relax, medication may be given through an IV (intravenous) line. You will lie on an exam table on your stomach, back, or side. This depends on where you will be injected. During your treatment: The skin over the injection site is cleaned. A local anesthetic (pain medication) numbs the skin. Fluoroscopy (x-ray imaging) may be used to help the doctor see your spine. If so, a contrast "dye" may be injected into the affected area. The injection is given. It may contain including a local anesthetic to numb the region around the joint or steroids (medications that reduce inflammation).

After the Procedure

Most often, you can go home in about an hour. Have an adult friend or relative drive you. When the anesthetic wears off, your neck may feel more sore than usual. This is normal. Rest and put ice on the area for 20 minutes a few times during the first day. The steroids most often begin to work in 3-4 days. Ask your doctor when it's okay to return to your job.


Medial Branch Neurotomy

Back or neck pain may be due to problems with certain nerves near your spine. If so, a medial branch neurotomy can help relieve your pain. The treatment uses heat, cold, or chemicals to destroy the nerves near a problem joint. This keeps some pain messages from traveling to the brain, and helps relieve your symptoms. Each vertebra in your spine has facets (flat surfaces). They touch where the vertebrae fit together. This forms a facet joint. Each facet joint has at least two medial branch nerves. They are part of the nerve pathway to and from each facet joint. A facet joint in your back or neck can become inflamed (swollen and irritated). Pain messages may then travel along the nerve pathway from the facet joint to your brain. Medial branch nerves in each facet joint send and carry messages about back or neck pain. Destroying a few of these nerves can keep certain pain messages from reaching the brain. This can help bring you relief.


Your Experience

The treatment is done in a hospital or surgery center. You'll be asked to fill out some forms, including a consent form. You may also be examined. You may be given an IV (intravenous) line for fluids and medications.

Getting Ready for Your Treatment

Ask your doctor whether you should stop taking any medications before treatment. Tell your doctor if you are pregnant or allergic to any medications. Stop eating or drinking 8 hours before you check in for your treatment.

During the Procedure

To help you relax, medication may be given through the IV line. You will lie on an exam table on your stomach, back, or side, depending on where the problem joint is. The skin over the treatment site is cleaned and then numbed with medication. Fluoroscopy (x-ray imaging) is used to help your doctor see the spine and guide the treatment. A contrast "dye" may be injected into the affected region to help get a better image. Heat, cold, or chemicals are used to destroy part of the nerve near the inflamed facet joint. Nearby nerves may also be treated. Relax at home for the rest of the day after your treatment, even if you feel good.

After the Procedure

Most often, you can go home in about an hour. Have an adult friend or relative drive you. The treated spot may be swollen and may feel more sore than usual. This is normal and may last for a day or so. It will be a few days before you feel relief from your symptoms. Your doctor may prescribe pain medications for you during that time. Ask him or her when it's okay for you to go back to work. Call your doctor if you have a fever over 101.0°F, chills, or redness or drainage at the treatment site.

Risks and complications are rare, but can include:
  • Infection
  • Increased pain, numbness, or weakness
  • Nerve damage
  • Bleeding
  • Failure to relieve pain

Electrothermal Catheter

Low back and leg pain is often due to damage to one or more of the disks between the vertebrae. Electrothermal therapy uses heat to change the structure of the tissue inside the disk. It doesn't relieve pain right away. Pain is reduced as the disk heals. After healing, the disk may also be stronger and more stable than before.

Inside the Disk

First, a needle is inserted into the disk. Then a special catheter (a flexible wire) is threaded through the needle, so that it curves around the inside of the disk. When the catheter is in place, part of it is next to the damage in the disk.

Heating the Disk

Once the catheter is in place, it is heated gradually to a high temperature. The catheter is kept at that temperature for a few minutes. Then it is removed. The heat may kill nerves in the disk, preventing these nerves from causing pain. The heat may also make the disk shrink. This may mean that the disk no longer presses on nerves. The heated tissue will slowly heal over the next few months and form scar tissue. This scar tissue may: Plug any leak in the disk. Make the disk stronger.

Getting Ready for Your Treatment

You'll have an exam to make sure you are healthy enough to have this procedure. You will also have tests that give information about your disk. These include: A discogram, which pinpoints the disk that is causing your pain. Imaging tests, such as an MRI or a CT, which may help your doctor learn more about how your disk is damaged.

Tell your doctor about all the medications you take. This includes over-the-counter medications, herbs, vitamins, and supplements. Stop taking medications as advised by your doctor. Stop eating and drinking 8 hours before the procedure. Arrange for an adult friend or family member to drive you home. Allow time to check in. You will need to sign a form stating that the procedure has been explained to you.

Arranging a few things ahead of time can make recovery easier and safer. Store supplies between hip and shoulder level. That way you can get to them without reaching or bending. Arrange for rides. You may not be able to drive for a week or more after the procedure. Find someone to help with chores and errands. Get a pair of slip-on shoes with closed backs. That way you won't have to bend to put on your shoes.

During the Procedure

An electrothermal therapy procedure may take up to 2 hours. During the procedure, you'll be awake but relaxed. That way, you can answer the doctor's questions about what you are feeling. You lie on your stomach or side. You have an IV (intravenous) line to give you fluids and medication. This includes a sedative to help you relax. Your heart and blood pressure are monitored. Your back is cleaned and covered with sterile drapes. Medication is given to numb the area. The needle is placed through your skin into the disk. Then the catheter is inserted through it into the disk.

Throughout the procedure, your doctor will ask whether you feel leg pain. This is to make sure that the catheter is not too close to certain nerves. During the procedure you may feel pain in your back. Telling your doctor how you feel helps him or her control any pain you may experience. If you are in pain, your doctor may heat the catheter more slowly or to a lower temperature. When the heating is finished, the catheter is removed. Antibiotics may be injected into the disk to prevent infection. Then the needle is removed.

After the Procedure

The procedure is over soon, but you won't recover overnight. For the first week, you may feel more back pain than usual. This is normal. It may take 6 months or more to reach full improvement of your back pain. Be patient and stick to your treatment plan to make sure you get better.

After your procedure while still in the hospital, you'll be moved to the recovery room. You may stay there for 1-2 hours. You'll be given pain medication if you need it. You will also be checked to make sure that your legs are not numb or weak. When it's time for you to leave, you'll be given: A prescription for pain medication to take at home. Instructions on how to take care of yourself during your recovery. A back brace, if needed.

For the first 4 weeks: Rest and heal at home. Be careful not to bend or twist. Limit your sitting time as advised by your doctor. During this time, you will have a follow-up appointment with your doctor. Depending on how your recovery goes: You may begin to exercise as directed by your doctor or physical therapist. You may return to work as soon as 4 weeks after the procedure.

Call the Doctor Right Away If You Have:
  • Increasing redness or drainage from your needle insertion site.
  • A fever above 100.0°F.
  • Loss of bowel or bladder control.
  • A severe headache.

Lumbar Epidural Injection

Your doctor may have suggested you have a lumbar epidural injection. This procedure can help relieve low back and leg pain by reducing inflammation (swelling and irritation). An injection also can help your doctor diagnose the source of your pain by numbing certain areas of your back. Where you are injected depends on the goal of the injection. A lumbar epidural injection won't stop all low back and leg pain. But it can reduce pain and break the pain cycle. This cycle may begin when back pain makes it hard to move. Lack of movement can then slow down healing. By getting you back on your feet, the injection can help speed your recovery. Some people may feel more relief from an injection than others. And some people may need more than one injection to get relief.


An injection can help locate the source of pain. Also called a selective nerve block or a selective epidural, it numbs the roots of specific nerves. The effect lasts only briefly. But if you feel relief, it may indicate the source of the pain. If you feel no relief, it may mean that the pain's source is at another level in your spine. Or it may mean that something other than inflammation is causing the pain. Injection results also may be used to help plan back surgery, if needed.

Getting Ready For Your Procedure

A lumbar epidural injection is an outpatient procedure. It's often done in a hospital or an outpatient surgery center. Before your injection, your healthcare provider will discuss how you need to prepare. You may need to prepare by doing the following: Give the doctor a list of all medicines you take, including aspirin and anti-inflammatories. (You may need to stop taking some of them before the injection.) Don't eat 6 hours before check-in, or drink anything 4 hours before. Arrange for an adult friend or family member to drive you home afterward. Bring any requested x-ray, CT, or MRI images on the day of the procedure.

During the Procedure

The injection takes just a few minutes. But extra time is needed to get ready. You may be given medicine before the injection to help you relax. Monitoring devices may be attached to your chest or side. These devices measure your heart rate, breathing, and blood pressure. You lie on your stomach or side, depending on where the injection will be given. Your back is cleaned and may be covered with sterile towels. Medicine is given to numb the skin near the injection site. If fluoroscopy (x-ray imaging) is to be used, a contrast "dye" may be injected into your back. This helps get a better image. A local anesthetic (for numbing), steroids (for reducing inflammation), or both are injected into the epidural space.

After the Procedure

You'll spend up to an hour in a recovery area. Before going home, you may be asked to fill out another survey about your pain.

Risks and complications are rare, but can include:
  • Spinal headache
  • Bleeding
  • Infection
Tips for Recovery at Home

You don't need to stay in bed when you get home. In fact, it's best to walk around if you feel up to it. Just be careful about being too active. Even if you feel better right away, avoid activities that may strain your back. And follow up on all treatment with your doctor. Keep in mind that some patients feel increased pain at first. It usually goes away within a few days. You may also have headaches or trouble sleeping. These should also go away within a few days. In general:

  • An injection to reduce inflammation takes a day or two to work. There may even be more pain at first.
  • An injection to help locate the source of pain may give only brief pain relief. Later, you'll feel the same as you did before the injection.
Whether you were injected for pain relief or diagnosis, these tips will help you recover:
  • Take walks when you feel up to it.
  • Rest if needed, but get up and move around after sitting for half an hour.
  • Don't exercise vigorously.
  • Don't drive the day of the procedure or until your doctor says it's OK.
  • Return to work or other activities when your doctor says you're ready.
When to Call Your Doctor Call right away if you notice any of the following symptoms:
  • Severe pain or headache
  • Loss of bladder or bowel control
  • Fever or chills