FACET JOINT INJECTIONS / MEDIAL BRANCH BLOCKS
The facet joints are small joints in the back that allow our back to flex and move. It is normal for these joints to age like the rest of our bodies, and what is often termed 'facet joint arthritis' or 'facet joint degeneration' is a normal consequence of ageing. Nevertheless, the facets joints can cause back pain and even pain radiating down the back of the legs or into the groin. Following a consultation and examination, injections around the facet joints, or medial branch blocks, targeting the nerves to the facet joints, are sometimes performed when your consultant suspects that the facet joints may be the cause of your pain. They are performed under local anaesthesia, using xrays to ensure that the injected medication reaches the relevant area. In common with many injections, a combination of local anaesthetic and a steroid* are used. The steroid is a strong anti-inflammatory medication, and it can reduce inflammation and therefore pain coming from the joints.
It can be very difficult from a discussion, examination or even scans to be certain about the precise structure in the back that is the cause of pain. Sometimes therefore, facet joint injections or medial branch blocks are performed to test a clinical suspicion that the facet joints are causing pain, as well as to provide longer-lasting pain relief. Following medial branch blocks, excellent pain relief, even if it is very short lived, gives good information and may suggest that a more permanent solution such as facet joint denervation will be helpful. A successful trial of facet joint injections can give many months of pain relief.
We perform many sets of facet joint injections each year with no complications. However, as with any medical treatment, there are some risks that we will discuss with you. Specifically, we will mention:
a risk that the treatment will not work for you
nerve damage (on average this happens about 1 in every 10,000 injections. It is rarely permanent)
BEFORE YOUR TREATMENT
Our usual practice is to see you for a consultation before your injection so that we can go through the treatment options with you, and detail any risks and benefits. An exception to this might be if you have had a similar treatment before and are coming for a repeat injection. It is extremely important that if you take any drugs that affect your blood clotting (eg warfarin, heparin, dalteparin, apixiban, clopidogrel etc) that you tell your Bath Pain Management consultant or our administrative team prior to the day of treatment, as there are some injections that we cannot perform whilst you are on those drugs. Usually however, facet joint injections and medial branch blocks can be performed whilst taking blood-thinners, but it is still important that you tell us if you are taking them.
We will endeavour to send you detailed information on any fees that apply before you come for your treatment. Again, please contact our administrative team if you have not received this information before the day of treatment.
ON THE DAY OF YOUR TREATMENT
On the day of your treatment you will be asked to attend the hospital a little while before the time of your injections. This is so that the nurses can get you ready for your treatment, and your Bath Pain Management consultant can see you to go through the treatment again and give you the opportunity to ask any questions that you might have. Having gone through risks and benefits of the treatment again, you will be asked to sign a consent form for the treatment, giving us permission to go ahead. However even after you have signed this you are perfectly entitled to change your mind at any time.
WHAT HAPPENS DURING THE TREATMENT
You will be asked to walk to the room where we will treat you. Sometimes you may go to the room on a trolley or on a bed. There will be a number of staff present in the treatment room including your consultant, one or two nurses and a radiographer. The radiographer's job is to operate the xray machine if one is required for your particular treatment. You will be asked some questions as part of a safety check. When this check is completed you will be helped into the correct position for the treatment. The consultant may perform some xrays at this point, then the treatment will be carried out. Prior to the treatment some local anaesthetic will be injected. This will sting for a few moments, but following this the treatments are often quite painless. Occasionally, particularly if you have had pain for a long time, the treatments can be uncomfortable, but your consultant will endeavour to reduce any discomfort to a minimum.
On rare occasions, we may offer you sedation for your procedure. Generally this is not necessary, and there are benefits to avoiding sedation if possible.
WHAT TO EXPECT AFTER THE TREATMENT
After the treatment, you will go back to your room on a bed or occasionally in a wheelchair. Once you have recovered from the treatment you will be able to go home. Usually you will be unable to drive yourself and will therefore need to make arrangements to be collected and accompanied home. Most of our patients are able to leave the hospital within an hour to an hour and a half of having their treatment.
FOLLOW UP ARRANGEMENTS
If you are a private patient you will receive a telephone call to check on your progress within three to four weeks. Please note that we are unable to leave answerphone messages for confidentiality reasons, unless your answerphone clearly states that you are the owner and we have your permission. You may be invited back for, or request a follow-up consultation to go through other non-injection treatment options.
We see a small number of patients through the NHS Choose and Book system. Generally follow-up would be provided by your GP, but we are obviously always happy to deal with any concerns you may have after your treatment.
*A note on the use of steroids in spinal injections
Although steroids have been used for many years safely in spinal injections, they are not licensed for this purpose. This means that the companies producing the steroid have not paid for a license allowing them to market the steroids for spinal injections. It does not mean that doctors cannot use them for this purpose, when the symptoms suggest they would be useful.
Your Bath Pain Management consultant will be happy to explain this in more detail to you if you wish.