What to Do Next if Facet Joint Injections Don’t Work
A facet joint injection is a minimally invasive procedure used to reduce facet joint pain. This pain is often caused by arthritis in the lumbar spine or cervical spine.
A review of studies published in the Journal of Orthopaedics
[1] found that facet joint injections effectively relieved pain for three months and potentially longer. The injections can also be repeated a few times a year.
However, there are instances where they may not be effective. Fortunately, alternative treatments are also available. The guide below covers what to do next if facet joint injections do not work.
What are Facet Joint Injections?
The facet joints connect the bones in your spine and allow you to move your torso in different directions, such as bending forward and twisting.
Various conditions affecting the back and neck, such as arthritis and traumatic injury, can cause facet joint pain.
Facet joint injections involve injecting a combination of a local anesthetic and steroid medication into the soft tissue around the facet joints.
The injections are delivered to the area causing the pain. For instance, facet injections are administered to the lumbar and cervical facet joints to treat lower back and neck pain.
When Will You Know if a Facet Joint Injection Is Not Working?
You may be unable to determine if the injection has worked immediately after the facet injection. The length of time it takes for the steroid medication to kick in and provide pain relief may vary.
In many cases, you may have reduced pain in 1 to 3 days
[2]. But in other instances, it can take a week for the steroid medication to help. Your doctor may suggest waiting a week to 10 days to determine whether facet joint injections provided significant pain relief.
Why Might a Facet Joint Injection Not Work?
It is difficult to predict if facet joint injections will work on someone. Typically, facet joint injections should work and provide temporary pain relief if patients display symptoms of facet joint pain.
However, every patient's experience is different. For example, a person's interpretation of their reduction in pain may vary.
Even if you appear to be a good candidate, facet joint injections may not work for your situation for several reasons. For example, the medication may not have reached the source of your pain.
It is also possible the facet joint is not the cause of your pain. Some people may have more than one back issue contributing to their pain.
If your facet joint injection did not reduce your pain, it is essential to inform your physician. Your doctor will let you know what the next step is if a facet joint injection does not work.
What if Pain is Worse After a Facet Joint Injections?
As with any medical procedure, side effects can occur after a facet injection. Facet joint injection side effects
[3] are typically minor, but can include:
- Swelling
- Pain at the injection site
- Temporarily increased back pain
In most cases, pain after a facet injection resolves quickly. However, initially, the pain may feel worse. This is usually a temporary side effect of the injection.
If someone develops worse pain after a facet joint injection that lasts more than a few days, they should contact their doctor.
What Are The Next Steps if a Facet Joint Injection Does Not Work?
It can be frustrating to deal with chronic pain. It may also be disappointing if your facet injection does not decrease pain. But what’s next if facet joint injections don't work? Fortunately, there are a few steps your doctor may suggest.
Additional Testing
If a facet joint injection fails to reduce pain, the next step may include additional testing to determine the exact cause of your pain. If the injection does not work, you may have pain due to something other than a damaged facet joint.
Testing may vary but can include:
- Additional imaging
- A bone scan
- Nerve studies
Chiropractic Manipulation
If you have not already tried chiropractic care, it may be an option to decrease pain and improve mobility. A misalignment in the spine can add pressure on the facet joint. Chiropractic care may restore proper alignment, relieve pressure, and reduce pain.
Discussion of Additional Treatment Options
Not every treatment is right for every individual. When an injection does not help, your doctor will review other treatment options for pain management. These may include other medications, physical therapy, or procedures. The benefits and risks of each treatment are discussed so you can make the best discussion possible.
What are Some Alternatives to a Facet Joint Injection?
The best alternative treatment to facet injections may depend on the exact cause of the pain. But possible alternatives include:
Spinal Blocks
A lumbar spinal nerve block uses a numbing agent injected into the space around your spinal cord called the epidural space. It helps numb the area to decrease pain. A spinal block may help treat several conditions that lead to back pain.
Radiofrequency Ablation
Radiofrequency ablation is a procedure that uses radio waves to deliver heat to an area of the nerve. The heat destroys the nerve fibers and prevents pain signals from being sent to the brain. It may help treat painful conditions, such as disc disease when other forms of treatment do not work.
Spinal Cord Stimulation
A spinal cord stimulator is a device that uses mild electrical current through the spine to block pain signals. It does not treat the cause of back pain. Instead, it changes the way the brain receives and perceives pain signals.
Surgery
Your doctor may discuss surgical options if other treatments have not helped reduce pain. In most cases, surgery is only recommended after less invasive treatments have not worked. The exact procedure suggested varies depending on the underlying cause of pain. As advances in surgery evolve, minimally invasive procedures may continue to be the better option.
Examples of surgery for back and neck pain conditions include:
- Discectomy: This procedure involves removing a herniated disc by pressing on a nerve root.
- Foraminotomy: In this surgery, the doctor enlarges the hole where the nerve root exits in the spinal cord. This helps prevent the bulging disks or thickened joints from pressing on the nerve and causing pain.
- Spinal laminectomy: This procedure may be helpful when spinal stenosis causes the spinal canal to narrow. The surgery involves removing any bone spurs and the bony walls of the vertebrae to widen or open up the spinal columns. This helps reduce pressure on the nerves, resulting in less pain.
Summary
Facet joint injections are a minimally invasive way to treat facet joint pain. But they may not work for everyone. A facet joint injection failure may occur for a few reasons, including the injection not reaching the source of pain or the joint not being the original pain source.
If a facet joint injection does not adequately treat your pain, you have other options. Treatment for chronic pain may vary and can include chiropractic care, physical therapy, radiofrequency ablation, and surgery.
Facet joint pain can significantly impact your mobility, comfort, and overall well-being. However, treatment is available. If a facet joint injection is not the right treatment for you, your physician will work with you to find the best solution. Treatment may help reduce pain, improve functionality, and quality of life.
If you have any questions or would like to schedule a consultation, please contact us today!
Sources
- Al-Najjim M, Shah R, Rahuma M, Gabbar OA. Lumbar facet joint injection in treating low back pain: Radiofrequency denervation versus SHAM procedure. Systematic review. J Orthop. 2017 Oct 27;15(1):1-8. doi: 10.1016/j.jor.2017.10.001. PMID: 29167604; PMCID: PMC5686472 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5686472/
- Epidural corticosteroid injections. (n.d.). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/epidural-corticosteroid-injections
- Le DT, Alem N. Facet Joint Injection. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572125/
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