What Is Facet Joint Pain and How Is It Recognised?
The facet joints are small joints that connect the vertebrae from behind, providing movement and stability. Over the years, wear (arthrosis) or strain can make these joints a source of pain. Facet-related pain is usually localised in the back, causes morning stiffness, worsens with standing and especially leaning backwards, may ease somewhat when sitting, and does not show sciatica-type dominant radiation into the leg. However, these features alone do not establish the diagnosis; similar complaints can arise from the disc and other causes. That is why the decision for facet treatment is, alongside examination and imaging, often confirmed with a diagnostic block — temporarily numbing the nerve branch carrying the pain to test whether the pain truly decreases.
How Are Facet Injection and Radiofrequency Denervation Done?
Both methods are performed without open surgery, under imaging (fluoroscopy) guidance. In a facet injection, a cortisone-type steroid with a local anaesthetic is delivered into or around the joint to calm inflammation and pain; this is both a treatment and a step that aids diagnosis. In radiofrequency denervation, controlled heat energy is delivered through a fine needle tip to the small nerve branch (medial branch) carrying the pain, temporarily reducing its pain transmission. The procedure is usually completed quickly under local anaesthesia. Key point: RF does not 'destroy' the nerve branch; it suppresses pain transmission for a time, and because nerve branches can regenerate over time, the effect may not be permanent and the pain may recur.
Who Is Suitable and Who Is Not?
A more suitable candidate is a patient whose pain shows a facet-joint pattern, who has facet arthrosis on imaging, and ideally in whom the pain source has been confirmed as facet with a diagnostic block. By contrast, if the true source of pain is disc herniation and nerve-root compression, if radicular leg pain predominates, or if there is progressive weakness, facet treatment is insufficient; in these cases epidural injection or — if indicated — surgery comes to the fore. So being 'non-surgical' does not make this method right for every back pain; if the source of pain is not correctly identified, time is lost. The determinant of success is choosing the right patient and the right source of pain.
Relation to Other Methods and the Stepwise Approach
Treatment is approached in steps: medication, correct exercise, physiotherapy, and lifestyle adjustment are tried first. In patients who do not respond sufficiently to these and whose pain is confirmed to be facet-related, facet injection and RF are a reasonable intermediate step. If pain arises from the disc and nerve root, epidural/transforaminal injection may be more appropriate, and for an intradiscal-pressure problem nucleoplasty may suit selected cases. These methods are not rivals; it is a matter of choosing the right tool for the right patient. Which method is appropriate is decided individually after clarifying the source of pain.
Recovery, Expectations and Risks
An advantage of RF denervation is that in the right patient it can provide pain reduction lasting weeks to months; this window makes physiotherapy and exercise easier. But one must be realistic: the effect may not be permanent, the pain may recur as nerve branches regenerate, and the procedure can be repeated when needed. The effect of a facet injection is also variable. No procedure is risk-free; rarely, infection, transient numbness, or pain at the site may occur, and these are discussed during informed consent. No 'guaranteed cure' can be promised for any method; in the long term, weight control, strengthening of back and abdominal muscles, and regular exercise are necessary for lasting recovery, whatever method is applied.