Facet joint injection

What is a facet joint injection?

The facet joints are small joints at the back of the spine, one pair at each level, that let your back bend and twist while keeping it stable. They can become a source of pain through wear and tear or injury. A facet joint injection puts a small amount of local anaesthetic, usually mixed with a steroid (an anti-inflammatory medicine), into or around one or more of these joints using X-ray or ultrasound to guide the needle.

The injection is used in two ways. As a test, the local anaesthetic can show whether numbing a particular joint takes the pain away, which points to that joint as the problem. As a treatment, the steroid is hoped to calm inflammation and give a longer settling of symptoms.

It is important to be realistic. A facet joint injection is not a cure and the relief, when it happens, is often partial and temporary. It is best thought of as one step within a wider plan that includes staying active, physiotherapy and self-management, not a stand-alone fix.

This matters because UK guidance is cautious. NICE (guideline NG59) says clinicians should not offer spinal injections for managing low back pain that has no specific cause. Where a facet joint is genuinely the suspected source, a diagnostic block is used mainly to decide whether radiofrequency denervation might help, rather than as a long-term treatment in its own right.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Facet joint injection vs medial branch block

The two procedures overlap and clinics vary in how they use them. Ask which one you are being offered and why.

Preparing for your procedure

• See a pain specialist who explains why this joint is suspected, what the injection can and cannot do, and how it fits your wider plan.
• Tell the team about all your medicines, especially blood thinners such as warfarin, clopidogrel or rivaroxaban, as these may need adjusting beforehand.
• Mention diabetes, as the steroid can raise blood sugar for a few days, and any allergy to local anaesthetic or X-ray dye (contrast).
• Tell the team if you might be pregnant, because X-ray guidance is usually avoided in pregnancy.
• You can usually eat, drink and take your normal medicines unless you are told otherwise.
• Arrange for someone to drive you home, as you should not drive for the rest of the day.
• Plan a quiet day or two afterwards in case the area feels sore.

What happens

You lie on an X-ray table, usually face down for a lower back injection. The skin is cleaned and a small amount of local anaesthetic is injected, which stings briefly and then numbs the area. Using an X-ray machine (or ultrasound), the specialist guides a fine needle to the joint. A little contrast dye may be used to confirm the position before the medicine is injected.

You stay awake throughout and may feel pressure or a brief ache as the medicine goes in. The injection itself takes only a few minutes, with the whole appointment lasting about 15 to 30 minutes.

Afterwards you rest in a waiting area for a short time so the team can check you are well before you go home. You will often be asked to note how your pain behaves over the next hours and days, as this helps judge whether the joint is the source.

Is this procedure right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The biggest issue is usually not danger but disappointment: many people get little or only short-lived relief, and NICE does not recommend spinal injections for ordinary low back pain. Ask your specialist what specific finding makes a facet joint the suspected source, what they expect the injection to achieve, and what the plan is if it does not help. Choose a service that uses image guidance and treats the injection as part of a broader plan, not a stand-alone cure.

Published figures to discuss

Reliable, comparable rates are hard to give because techniques, joints and patient groups vary, and much of the published evidence is of modest quality. Serious complications are rare; the more common problem is limited or short-lived benefit. Where ranges are quoted, they should be treated as cautious estimates rather than precise figures.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is usually little physical recovery. Many people go back to normal activities the same day or the next, though the back can feel sore for a few days and any benefit takes time to show.

• A short spell of increased pain for 2 to 3 days after the injection
• Mild bruising or tenderness at the needle site
• Feeling flushed or warm for a day or two from the steroid
• Gradual, partial easing of pain rather than a sudden complete fix
• Relief that may fade after weeks to months

Aftercare

• Keep the injection site clean and dry for 24 hours.
• Do not drive for the rest of the day; arrange a lift home.
• Use simple pain relief such as paracetamol if the area is sore, unless told otherwise.
• Ease back into normal activity over a day or two; avoid heavy lifting or strenuous exercise for about 48 hours.
• Keep a simple diary of your pain levels and how long any relief lasts.
• Continue your physiotherapy and stay as active as your pain allows.
• Contact the clinic or your GP if you notice signs of infection or worsening symptoms. For urgent advice, use NHS 111 in England, Scotland or Wales, or your GP out-of-hours or HSC Trust Phone First service in Northern Ireland; call 999 or go to A&E in an emergency.

• Someone to drive you home
• A note of your usual medicines, especially blood thinners
• Simple pain relief at home
• A quiet day or two planned
• A pain diary or notes app ready
• The clinic's contact number and your urgent-care number saved (NHS 111 in England, Scotland or Wales; GP out-of-hours or HSC Trust Phone First in Northern Ireland)

⚠ Get urgent help if…

• Spreading redness, heat, swelling or discharge at the injection site
• Fever, chills or feeling generally unwell in the days after the injection
• New or worsening leg or arm weakness, numbness or pins and needles that does not settle
• Loss of control of your bladder or bowels, or numbness around the back passage (seek emergency help)
• A severe headache, especially when sitting or standing up
• Chest pain or breathlessness after a chest (thoracic) injection (seek urgent help)

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A helpful result is a clear, time-limited drop in your usual pain after the injection. If local anaesthetic was used, an early improvement that matches how long the anaesthetic lasts suggests the joint is involved. If a steroid was used, any benefit builds over a few days.

A facet joint injection cannot prove a long-term cure, and a poor response does not mean your pain is imaginary. It simply means that joint is unlikely to be the main source, or that an injection is not the right tool. Your specialist uses the result, alongside your symptoms and examination, to decide what to do next.

When a steroid injection helps, the relief is often temporary, lasting from a few weeks to a few months and sometimes not at all. Some people get longer benefit, but injections are not a permanent solution and repeating them indefinitely is not advised. If relief is short-lived, your specialist may discuss a medial branch block and radiofrequency denervation, or a stronger focus on rehabilitation.

Related tests, treatments or support

Facet joint injections are most useful alongside other care, especially physiotherapy and an active self-management plan. They are sometimes used as a step before deciding on radiofrequency denervation. They are not a substitute for staying active, and a responsible service will not offer the injection in isolation.

Follow-up & long-term care

You should have a review to discuss how much relief you got and how long it lasted, usually a few weeks later. This review decides whether to repeat the injection, move to a different procedure, or concentrate on rehabilitation. Report any signs of infection or new nerve symptoms straight away rather than waiting.

• Keep up physiotherapy and regular activity, which often matters more than the injection itself
• Track how long any relief lasts so repeat injections are only used when genuinely helpful
• Review your overall pain plan regularly rather than relying on repeated injections

Repeat, follow-on and what comes next

• Repeat injections are sometimes done, but indefinite repetition without clear benefit is not recommended.
• If relief is poor or very short-lived, the diagnosis or approach should be reconsidered rather than simply repeated.
• A poor response often means the facet joint is not the main source, prompting a different test or treatment.
• A short-lived diagnostic response may lead on to a medial branch block and radiofrequency denervation.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A named contact route at the clinic and clear advice to use urgent care for red-flag symptoms - NHS 111 in England, Scotland or Wales, or GP out-of-hours or HSC Trust Phone First in Northern Ireland, and 999 or A&E in an emergency.
• A planned review to judge how much relief you got and how long it lasted.
• Written advice on the normal 2 to 3 day sore spell and how to manage it.
• Integration with physiotherapy and a self-management plan rather than injections alone.
• An honest discussion of next steps if the injection helps little or only briefly.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The specialist's fee for assessing you and performing the injection
• The facility or imaging suite fee, including X-ray or ultrasound guidance
• Whether one joint or several are injected, and one or both sides
• Contrast dye and the medicines used
• Any sedation, if offered (most are done with local anaesthetic only)
• Follow-up appointments to review the result
• Whether the same fee covers a repeat injection if needed

• The specialist's fee and who will perform the injection
• The facility and imaging (X-ray or ultrasound) fee
• How many joints and sides are included in the price
• Medicines and contrast dye
• A follow-up review to assess the result
• What happens, and what it costs, if a repeat or different procedure is needed
• The policy if the injection gives little or no relief

On the NHS? Facet joint injections are available in some NHS pain services, usually when a facet joint is the specific suspected source; NICE does not recommend spinal injections for ordinary low back pain, and private access may be used for speed or choice.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• What specific finding makes you think a facet joint is the source of my pain?
• Is this injection mainly to diagnose, to treat, or both?
• What relief do you expect, and how long might it last?
• What is the plan if it gives little or no relief?
• How does this fit with my physiotherapy and self-management?
• Will you use X-ray or ultrasound guidance, and who will do the injection?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my procedure, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this procedure not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for facet joint injection

Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.

How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NICE NG59 — Low back pain and sciatica in over 16s (recommendations) NHS (Guy's and St Thomas') — Facet joint injections for treating pain NHS (North Bristol) — Facet joint injections patient information Faculty of Pain Medicine — Patient information leaflets Image-guided lumbar facet joint infiltration — PMC review NICE NG59 — Update information (psychological-therapy recommendations withdrawn) nidirect — Urgent and emergency care services (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.