Treatment for Chronic Back Pain: Facet Injections and Radiofrequency Ablation

Updated on April 3, 2018
kortneypac profile image

Kortney has been a clinical physician assistant for 13 yrs. When not being a PA, Kortney’s hobbies include writing, research, and investing.

What is Facet Mediated Pain?

When someone is suffering from lower back or neck pain, there are several potential causes for that pain.

Spinal pain could come from:

  • degenerative discs
  • herniated discs
  • instability
  • compression fracture
  • neural foraminal narrowing or nerve root compression
  • central canal stenosis (narrowing of the central spinal canal)
  • facet joints

What is a Facet Joint?

In order to understand facet mediated pain (or pain that originates at the facet joint), it is first necessary to understand what a facet joint is.

The spine is made up of several bones that are aligned in a vertical manner. These bones are called vertebra. Each vertebra is made up of a vertebral body and a central canal or round opening through which the spinal cord travels. The areas around the spinal canal are referred to as pedicles (right and left) and lamina (posterior).

Posteriorly, there is a spinous process, which is a bony projection from the lamina. There are transverse processes that extend out from the pedicles on both sides (right and left).

Between each vertebra, there is a disc, which is a cartilaginous, jelly-like substance that provides cushioning between each vertebral level. There are ligaments that attach the spinous processes and lamina of each level and ligaments that run along the vertebral bodies and intervertebral discs connecting the levels together.

In between each vertebra, there are intervertebral foramen or openings where the spinal nerve roots exit the spinal cord and travel down into the arms (cervical) or legs (lumbar). In addition to the discs and ligaments, the vertebral levels are connected by facet joints.

Each vertebra has four articular facets, which connect one vertebra to another vertebra. Two superior articular facets (right and left) connect a vertebra to the adjacent vertebra above it and two inferior articular facets (right and left) connect a vertebra to the adjacent vertebra below it.

The point where the facets meet between each vertebra is referred to as the facet joint. Each vertebral level of the spine has right and left facet joints where they connect with the levels adjacent to them.

The cervical spine is made up of 7 vertebral levels, referred to as C1 (also known as the atlas), C2 (also known as the axis), C3, C4, C5, C6, and C7. The thoracic spine contains 12 vertebral levels, referred to as T1–T12. The lumbar spine is made up of 5 vertebral levels, referred to as L1–L5. There is also a sacral level, which is referred to as S1 that is just below the L5 level.Facet joints are located between each of these vertebral levels.

The facet joints are primarily made up of bone and can degenerate or become arthritic over time. As they degenerate, they become bumpy, rough, sharp, and jagged. When this happens, it can cause pain with motion, particularly with backward extension and rotation of the spine. The most commonly affected levels are the lower levels of the lumbar spine, referred to as L4-5 and L5-S1 facet joints (right and left sided).

Facet mediated pain is literally pain that originates at these facet joints due to degeneration of the joint, abnormal alignment of the spine, scoliosis, disc changes, etc. It can be either a degenerative process that develops over time or a result of an acute traumatic injury. Either way, facet mediated pain can be quite painful.

Facet mediated pain may:

  • worsen when bending backwards and rotating to the side
  • improve when bending forwards
  • be localized in the spine and does not radiate to the arms or legs
  • be associated with popping, clicking, or crackling sounds with movement


What Types of Treatment Are Available for Facet Mediated Pain?

Typically, initial treatment would include a course of physical therapy, exercise, and/or chiropractic treatment paired with the use of nonsteroidal anti-inflammatory medications (ibuprofen, Naproxen). If this initial treatment fails to adequately relieve symptoms, the next step could be injections. Physicians will typically obtain an imaging report, such as x-rays or an MRI first before administering injections.

How Are Facet Joint Injections Performed?

Facet injections are usually administered in an outpatient surgical setting or in the physician's office as long as there is a sterile environment.

  • The physician will numb the area and then place a long needle into your neck or back while using a type of imaging modality that is similar to ultrasound (fluoroscopy) to visualize the needle and to ensure that the correct area is chosen for injection.
  • An injection can be administered directly into the facet joints or it can be administered to the medial branch of the nerve that innervates the joint. Either way, the goal is for the injection to provide both immediate relief of pain and then long-term benefit.


How Do Facet Injections Work?

Facet injections are typically administered for one of two reasons: 1) Diagnostic purposes; 2) Therapeutic purposes. When being administered for therapeutic purposes, these injections are generally only capable of providing short-term relief of pain. However, if there is a diagnostic response to facet injections with evidence of pain relief, then patients can be considered for a radiofrequency ablation procedure at the facet joints.

During radiofrequency ablation, the nerve that innervates the facet joint is burned with a hot coil with the intention of causing it to lose its ability to cause painful sensations. When this treatment is administered, patients can expect more long-term pain relief, typically for 3–6 months or longer. In some cases, pain can return in six months because the nerve can regenerate. When this occurs, the typical recommendation is for repeat radiofrequency ablation, as long as there was significant relief of pain and improvement in function with the initial procedure.

My Experience Working with Chronic Back and Neck Pain as a Physician's Assistant

I am currently working as a physician assistant and have been working in occupational medicine and orthopedic surgery for the last 13 years. My current job entails peer reviews for medical treatment requests within the workers' compensation industry throughout the United States, but with a focus in California, Massachusetts, Louisiana, Texas, Tennessee, and New York. I have seen tens of thousands of cases of chronic lower back and neck pain in the last 13 years. In my experience, patients who continue to have pain despite physical therapy, activity modification, and medications, may feel somewhat frustrated with the persistence of their pain and overwhelmed by the various potential treatment options that are currently available.

In my other articles, I have written about various treatments for chronic pain, including epidural steroid injections, topical medications, oral medications, and ergonomic updates. This article focuses on facet mediated pain in the neck and lower back and the indications, outcomes, risks, etc. of facet injections for neck and lower back pain.

Please feel free to leave a comment at the end of this article if you are in need of information on any other specific treatments for chronic pain or orthopedic injuries (knees, shoulders, back, neck, wrists, ankle, etc.).

Pain Epidemic

Have you suffered from neck or lower back pain? What treatment has helped you the most?

See results

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

  • What are the side effects of Facet Injection therapy?

    With diagnostic facet injections, typically, only a local anesthetic is used, such as lidocaine. These anesthetics have a short duration of action and wear off after 30 minutes or up for 10 hours, dependent on the agent used. As such, side effects are rare and minimal and would include pain associated with the needle stick and injection, temporary loss of sensation, and rare potential for more systemic reaction to the anesthetic. With spinal injections, there is always a risk for needle stick into the dura, which could cause temporary or permanent neurological impairment. However, this is very rare with facet injections. When a steroid is administered, there is a risk for temporary increases in blood glucose, especially in diabetics, development of scar tissue in the area, and a mild potential for a more diffuse steroid reaction if there is hypersensitivity to the steroid or other endocrinological abnormalities.

  • I am five weeks out from a Radio Frequency Ablation with no pain relief. I have talked to the nurse three times over this last weeks and she just tells me that the RFA usually doesn't kick in until the third or fourth week. I am becoming increasingly frustrated and tired of the pain. I take Neurontin twice a day and Tylenol as needed. How do you think I should proceed?

    If you haven't had any pain relief at three to four weeks following Radiofrequency ablation, it is possible that your pain is not coming from the facet joint that was treated. I would make an appointment with your doctor to discuss this. Radiofrequency ablation is a procedure that burns the nerve in the facet joint. Once that nerve end is burned off, there should no longer be any painful signals sent to the brain. I typically consider this procedure to be unsuccessful in any patient who has not had relief within the first one to two weeks after the procedure. It is likely that there is something else that is causing your pain.

  • Why would my doctor want to do two medial branch nerve blocks before a radio frequency?

    Typically, doctors want to make sure that the facet joint is the cause of your pain before going in and burning the nerve supply to that facet joint with the radiofrequency ablation. The first injection is usually with a short-acting anesthetic, such as lidocaine, to determine if there is immediate relief of pain after the injection. If there is a positive response, then a second injection is administered at a later date using a different, more long-acting anesthetic, such as bupivacaine. This helps to rule out a false positive response to the initial injection. If there is a sufficient amount of relief with both injections, then it is more likely that the facet joint is the cause of the pain.

  • After RFA, How long to see if it worked?

    Usually, patients experience immediate pain relief after RF ablation. The procedure is supposed to burn the ends of the nerves, which would result in that nerve not being able to send painful signals to your brain. Once the nerve regenerates, pain can return, but this usually doesn't happen until about six months or more after this procedure. If you aren't having immediate relief of pain after undergoing RF ablation, then there could be another cause for your pain. You should talk to your doctor about what else could be causing your pain.

  • I have been having lower back pain for a while. My doctor gave me pain meds that relieved the pain for a certain amount of time. I can't bend forward or backward without the pain, and I have to sleep with a pillow under my back to ease some of the pain. Can you please recommend what I should do to get back to myself pain-free? I work with disabled individuals, and I can't work with this pain.

    Unfortunately, there is not a simple answer to your question. I have learned over the last 13 years of working in orthopedics that treatments and treatment responses can vary significantly among patients. What works for one person with back pain may not work for another. If you are not responding to medications, have you been referred for any therapy, such as physical therapy, chiropractic therapy, or acupuncture? All of these are typically recommended on an initial basis before injections. If you have tried therapy without success, I would talk to your doctor about how much pain you're having. If you didn't already have an MRI, that would most likely be your next step. If you do have pathology on the MRI, your doctor will then be able to recommend injections, alternative treatments, or possibly surgery. I understand how you must be feeling, and I'm very sorry that you haven't found any treatments yet that have worked. My recommendation would be to be very honest and frank with your doctor about how much pain you are in and hopefully, he can refer you for imaging, treatments, injections, or to another doctor who can help. I wish you all the best. Feel free to ask another question if I haven't answered this question adequately.

© 2018 Kortney T


    0 of 8192 characters used
    Post Comment
    • profile image

      Harvey Becker 

      17 months ago

      Excellent article!!

    • kortneypac profile imageAUTHOR

      Kortney T 

      2 years ago from Lewiston, NY

      Hi Barbara! This type of treatment/injection is usually administered by a pain management physician or a PM&R physician. In some cases, you won't be able to just call a pain management doctor and ask for an appointment because they want you to be referred to their office by an orthopedic doctor who has already evaluated your condition. However, if you want to try, you can call some pain management doctors in your area. Otherwise, I'd ask your primary care physician or your orthopedic doctor if they will refer you so that you can talk to a pain management doctor about this treatment. I wish you the best!

    • profile image

      Barbara Cardwell 

      2 years ago

      Any suggestions on how I would proceed would be appreciated

    • NewLifeOutlook profile image


      2 years ago

      Hi Kortney, wow! Thank you so much for the very detailed answer back to my question. You answered it perfectly! It has definitely opened up my eyes more to this procedure and how you would also look into alternative causes of their pain. Thank you so much again.

    • kortneypac profile imageAUTHOR

      Kortney T 

      2 years ago from Lewiston, NY

      Hello Albert Neal! Thank you for reading my article and for sharing your story with me! I’m sorry to hear about your experiences with spinal disorders. I have been treating patients with chronic pain from spinal disorders for a long time, so I understand what you have been going through. I am happy to hear that you found treatments that work for you! I really appreciate your feedback and thank you again for sharing your story!

    • kortneypac profile imageAUTHOR

      Kortney T 

      2 years ago from Lewiston, NY

      Hi NewLifeOutlook! Thank you for leaving a comment. I would like to clarify with you what treatment is expected to provide 3-6 months of relief. Most patients are first administered a facet injection which includes a steroid and a local anesthetic or a facet injection with just a local anesthetic. The purpose of the first injection in most cases is to see if there is relief of pain so that patients can be considered for radiofrequency ablation, which is a procedure that involves a hot coil that burns the nerves in the facet joint and stops them from delivering painful sensations. In my experience, a facet injection with local anesthetic only provides relief for several hours or up to 2-3 days. A facet injection with local anesthetic and a steroid may provide relief for 2-6 weeks or longer in some cases. It is the radiofrequency ablation that is capable of providing more long term relief of pain for 3-6 months or longer in some cases. However, I have also seen patients who had return of pain within 1-2 months after the procedure. In patients who have an early return of pain, I typically would consider an alternate cause for their pain, such as pain from degenerative discs, spinal stenosis, instability of the spinal vertebral segment, or possibly even pain that comes from the sacroiliac joints. If you have had a radiofrequency ablation and have early return of pain, I would encourage you to discuss the possibility of another cause of pain with your doctor. Alternatively, if your doctor administered facet injections only and you had short term relief of pain, I would suggest discussing radiofrequency ablation with your practitioner. Good luck, I wish you the best!

    • profile image

      Albert Neal 

      2 years ago

      Ms.Tholen: Excellent article, thank you.Although familiar with most of the listed treatment modalities, I still learned more from you. I had an incomplete fracture of C-3 with 10 compression fractures in the lumbar spine. Focused exercise, physical therapy and injections as well as medications have all helped.

    • NewLifeOutlook profile image


      2 years ago

      Great hub Kortney! I just have a quick question about the longevity of facet injections. You said that it is administrated every 3-6 months. Have there been any cases where a patient has needed to come back earlier than three months to get another shot?


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
    ClickscoThis is a data management platform studying reader behavior (Privacy Policy)