What are symptoms of cervical facet pain?

Acute episodes of cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year. Most patients will have a persisting point tenderness overlying the inflamed facet joints with some degree of loss of range of motion and typically be more discomfort on slightly leaning backwards than on leaning forwards. Cervical facet joint problems may radiate pain locally or into the shoulders or upper back, but rarely doe cervical facet joint pain radiates in the front or down an arm or into the fingers. 

What are cervical facet joints? 

Cervical facet joints are small joints located in pairs on the back/side of your neck, they provide stability and guide motion in your spine. 

Why are facet joint injections helpful? 

If the joints become painful due to arthritis, injury, or mechanical stress, they can cause pain in various areas. The cervical facet joints can cause pain in your head, neck, shoulder or arm. A facet joint injection or facet nerve blocks serve several purposes: 1. diagnostic - if you obtain complete pain relief or significant pain improvement of your main pain while the facet joints are numb, then these joints are likely source of your pain; 2. therapeutic - time-release cortisone that is injected into these joints or around the facet nerves reduce any presumed inflammation and may provide long-term pain relief. 

What happens before treatment? 

The doctor who will perform the injection will review your medical records and imaging studies to plan for the best location for these injections. Patients who are taking aspirin or blood thinners may need to stop taking the several days before epidural steroid injection, doctor will provide specific instructions. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection. The injection is usually performed in an outpatient procedures suite that has access to fluoroscopy. You will need make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

What happens during treatment? 

Before your injection, you will be asked to sign consent forms, list medications you are taking, and list any allergies to medications. Procedure may last 15-30 minutes followed by a recovery period. Patients remain awake for these procedures. Sedatives can be given to help lessen anxiety.  The patient will be lying face down on the table, will receive a local anesthetic, which will numb the skin before the injection is given. If IV sedation is used, your blood pressure, heart rate and breathing will be monitored during the procedure.  With the aid of a fluoroscope (a special X-ray), the doctor will direct a hollow needle through the skin and muscles of your neck into the cervical facet joints or next to facet nerves. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes into correct location. Contrast agent may be injected to confirm correct needle position and desired medication spread. Some discomfort may occur, but patients typically feel more pressure than pain.  After the needles are confirmed to be in correct position, the doctor will inject long acting corticosteroid medication into your cervical facet joints or next to the facet nerves. Needles are then removed. 

What happens after treatment? 

Most patients can walk immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home. Typically patients will resume full activity the next day. If soreness around the injection site is present the following day, it may be relieved by using ice and taking mild pain medications such as Tylenol. The doctor’s office may want to follow up with you 7 to 14 days after the procedure to assess you response to this injection. You may be provided a diary to record you response to this procedure. You may notice a slight increase in pain after the numbing medicine wears off and before the corticosteroid medication starts to take effect. If facets are the source of pain, you may begin to notice pain improvement in two to five days after the injection.  If you experience no or a little pain relief, then it is unlikely that you will benefit from more injections. Additional diagnostic tests may be needed to accurately diagnose your pain. If you experience recurrence of your neck pain after a short period of time and you’ve experienced good pain relief with the facet injections or facet nerve blocks, you may be a candidate for a procedure that uses a radiofrequency probe to destroy some of the nerve fibers causing pain and produce longer duration pain improvement - radiofrequency rhizotomy.

What are the risks?

 The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare), corticosteroid medication induced side effects such as weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These usually resolve within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, or those who cannot temporarily discontinue anti-clotting medication) should consult their personal physician for a risk assessment.  With few risks, epidural steriod injections are considered an appropriate nonsurgical treatment for some patients.

How long can I expect pain relief?

The length of time that you can expect pain relief depends on the amount of inflammation you have.  Sometimes an injection can bring several months of pain relief, and then further treatment is needed.  Other times, a single injection can bring long-term pain relief.  If your pain is caused by injury to more than one area, only some of your symptoms will be helped by a single injection.