Facet Joint Injections in Castle Rock
What is a Facet Joint Injection?
A facet joint injection places steroid medication directly into one or more facet joints - the small joints along the back of the spine that connect each vertebra to the one above and below it. These joints allow the spine to bend and twist, and over time they can develop arthritis, just like a knee or hip. When a facet joint becomes inflamed, it can cause pain in the neck, mid-back, or lower back that is typically worse with extension (leaning back) and twisting.
Facet joint injections serve two purposes. First, they are diagnostic - if the injection significantly reduces your pain, it confirms that the facet joint is the source. Second, they are therapeutic - the steroid reduces inflammation and can provide relief lasting weeks to months.
How is a Facet Joint Injection Different from a Medial Branch Block?
Both procedures are used to evaluate and treat facet-related pain, but they work differently.
A facet joint injection places medication inside the joint itself. It uses a steroid to reduce inflammation and can provide direct therapeutic relief.
A medial branch block targets the small nerves outside the joint that carry pain signals to the brain. It uses only a numbing agent (no steroid) and is primarily diagnostic - its purpose is to confirm the pain source before proceeding with radiofrequency ablation (RFA), which provides longer-lasting relief.
Dr. Carrera's team will recommend one approach or the other based on your imaging, how long you have had symptoms, and your treatment goals. In some cases, a facet joint injection is the right first step. In others, going directly to medial branch blocks and the RFA pathway makes more sense. More information is available on the medial branch block page and the radiofrequency ablation page.
What Conditions are Treated with Facet Joint Injections?
Facet joint arthritis (spondylosis) in the neck, mid-back, or lower back
Whiplash injuries affecting the cervical facet joints
Facet joint syndrome
Chronic neck or back pain that is worse with extension or twisting
Post-surgical spine pain when facet joints are a contributing source
What About PRP Instead of Steroids?
Dr. Carrera's team also offers platelet-rich plasma (PRP) injections into facet joints as an alternative to steroids. PRP uses your own blood's healing factors to promote tissue repair rather than simply reducing inflammation. It may be a good option for patients who want to avoid repeat steroid injections or who are looking for a potentially longer-lasting effect. PRP is typically a cash-pay procedure. More details are available on the PRP page.
How Should I Prepare?
Wear loose, comfortable clothing that allows easy access to your neck or back. Blood thinners generally do not need to be stopped for facet joint injections, though the team will advise you if any medication changes are needed. IV sedation is rarely required. For cervical (neck) injections, arrange for someone to drive you home, as mild dizziness or temporary numbness can occur.
What Happens During the Procedure?
You will lie face down on a procedure table. The skin is cleaned and numbed with a local anesthetic. Using fluoroscopy (live X-ray), a thin needle is guided into the facet joint. A small amount of contrast dye may be injected to confirm the needle is inside the joint. The steroid and anesthetic mixture is then injected. The procedure takes about 2 minutes.
How Much Does It Hurt?
Most patients tolerate facet joint injections well. The skin is numbed before the needle is placed, and the injection itself causes brief pressure or mild discomfort. Patients generally rate the experience between 3 and 5 out of 10. The entire procedure is quick, and many patients are relieved by how straightforward it is.
What Should I Do After the Procedure?
Avoid strenuous activity for 24 hours.
Resume normal activities gradually the following day.
Avoid submerging the injection site in water for two days.
Do not apply heat directly to the injection site for 48 hours.
Keep a pain diary after the procedure. Note your pain level before the injection, immediately after, and over the following hours and days. This information helps your provider determine whether the facet joint is the source of your pain.
When Will I Feel Better?
Immediate relief from the local anesthetic may last about two hours. The steroid typically begins working within one to two days, with full effects developing over about a week.
How Long Does the Relief Last?
About 60% of patients experience at least 50% pain reduction for three months or longer. If the injection confirms the facet joint as the pain source but relief is short-lived, Dr. Carrera's team may recommend radiofrequency ablation (RFA) for longer-lasting results - typically 6 to 18 months per treatment.
How Often Can Facet Joint Injections Be Repeated?
If the injection provides meaningful relief, it can be repeated approximately every three months. To limit steroid-related side effects, total steroid injections should generally not exceed five per year across the body. If you are needing frequent repeat injections, the team will discuss whether RFA or PRP might provide more durable relief.
Does Insurance Cover Facet Joint Injections?
Yes. Most insurance plans cover facet joint injections when criteria are met - typically chronic pain for at least three months with failure of conservative treatments and imaging (usually MRI) confirming facet joint changes. Prior authorization may be required, and the team handles this in-house.
What Comes Next If the Injection Helps?
If the facet joint injection confirms that the joint is the source of your pain, the next step depends on how long the relief lasts and your treatment goals:
Good relief lasting several months: Repeat facet joint injections as needed, or consider PRP for a steroid-free alternative.
Short-lived relief (confirms the diagnosis but wears off quickly): Proceed with medial branch blocks followed by radiofrequency ablation for longer-lasting results.
Minimal relief: The facet joint may not be the primary pain source. The team will re-evaluate and consider other diagnoses.
Schedule a Consultation
If your back or neck pain is worse with leaning back, twisting, or prolonged standing, the facet joints may be the source. Dr. Carrera's team can determine whether a facet joint injection is the right diagnostic or treatment step.