Epidural and Facet Injections for Spinal Pain

Your doctor may recommend an epidural or facet injection for two purposes:

• Diagnosing the source of back or neck pain. Your doctor will inject anesthetic medicine around a specific nerve or facet joint. If it relieves your pain, then that nerve or facet joint is the source of your pain. If it does not relieve your pain, then your doctor will look for another source.

• Treating back or neck pain. Your doctor can inject anesthetic or long-acting anti-inflammatory medicine to relieve pain and reduce swelling. This includes corticosteroids. Your doctor can also destroy the nerve fibers that are causing pain with a drug, called a chemical neurolytic, or with an electrical current, called radiofrequency ablation.

Epidural and facet injections can help control pain enough to start a physical therapy or rehabilitation program with minimal discomfort. 

Your doctor may recommend an epidural or facet injection for the following conditions: 

• Arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis

• Nerve compression, including sciatica

• Postoperative pain syndromes, including failed back syndrome

• Spinal disc problems, including bulging, herniated or ruptured spinal discs

• Spinal injuries, including spinal fractures

• Spinal stenosis, which is a narrowing of the spinal canal

The following specialists commonly perform epidural and facet injections:

• Neurologists specialize in problems of the brain and nervous system, including the spinal cord, nerves, muscles, and related blood vessels.

• Neurosurgeons specialize in the medical and surgical care of people with diseases and conditions of the brain and nervous system.

• Orthopedic surgeons specialize in treating problems of the bones and joints.

• Physical medicine and rehabilitation doctors specialize in muscle, bone, and nervous system conditions that affect physical and mental ability.

Other specialists who perform epidural and facet injections include:

• Anesthesiologists specialize in preventing and relieving pain.

• Radiologists specialize in imaging and image-guided procedures.

Your epidural or facet injection will be performed in an outpatient setting. It is a minor procedure that involves the following steps:

1. You will lie face down on a procedure table.

2. You may have a sedative to help you relax, but you will remain awake to tell the doctor about your pain.

3. Your doctor will clean your back and numb your skin. 

4. Your doctor will use a special X-ray, called fluoroscopy, to insert a needle into your spine. Fluoroscopy helps your doctor place the needle at the precise facet joint or nerve.

5. Your doctor will inject medicine once the needle is in place.

6. Your doctor may repeat the procedure on another nerve or facet joint.

7. You will recover for up to an hour and then go home.

8. You will likely return in about a week so your doctor can evaluate your pain.

9. You can repeat the procedure three times a year if needed.

Will I feel pain with an epidural or facet injection?

Your comfort and relaxation is important to both you and your care team. You may feel discomfort or pressure when your doctor inserts the needle. You may also feel a mild burning when the doctor injects the medicine. Take a few long, deep breaths to help yourself relax. Tell your doctor if any discomfort does not pass quickly. 

Complications after an epidural or facet injection are not common, but any medical procedure involves risk and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of an epidural or facet injection include: 

• Allergic reaction

• Bleeding

• Infection

• Muscle weakness 

• Nerve injury

• Numbness, which is usually temporary

• Spinal headache

• Worsening pain, which is usually temporary

Reducing your risk of complications

You can reduce the risk of certain complications by: 

• Following activity, exercise and lifestyle restrictions and recommendations 

• Following instructions after the procedure exactly

• Informing your doctor if you are nursing or if there is any possibility of pregnancy

• Keeping all scheduled appointments

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed 

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before your epidural or facet injection can improve your comfort and outcome. You can prepare for an epidural or facet injection by:

• Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Preparing for an epidural or facet injection can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

• Why do I need an epidural or facet injection? Are there any other options for treating my condition?

• How long will the procedure take? When can I go home?

• What restrictions will I have after the procedure? When can I return to work and other activities?

• How will you treat my pain?

• What kind of assistance will I need at home? Will I need a ride home?

• How should I take my regular medications?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect after an epidural or facet injection can help you get back to your everyday life as soon as possible. 

What can I expect after the treatment?

You will go home soon after your epidural or facet injection. Someone needs to drive you home because you may have numbness and difficulty walking for a few hours. You will need to rest for the day, so it is also a good idea to have someone stay with you. Most people resume normal activities the following day. 

You will return to your see your doctor after the medicine has had time to work. Epidural injections can take a couple of days to reach their full effect. Your doctor will evaluate your pain after several days and decide whether another injection is necessary. 

You may have some soreness around the injection site. Your doctor may have you apply ice or take over-the-counter pain medicines. Tell your doctor if you have more pain, swelling or bruising than expected.

When should I call my doctor?

It is important to keep your follow-up appointments after an epidural or facet injection. Contact your doctor if you have concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding

• Difficulty breathing

• Dizziness or fainting

• Drainage from the injection site

• Fever 

• New or unexplained symptoms

• Pain that is not controlled by your pain medication

• Persistent weakness, numbness or tingling in your arms or legs

• Rash or skin irritation

• Severe or persistent headache or back pain

How might an epidural or facet injection affect my everyday life?

Results of epidural and facet injections vary from person to person. Pain relief can last for several days or several months. This is often enough to help people start a physical therapy or rehabilitation program for more lasting relief. However, some people may need to repeat the procedure. If an epidural or facet injection does not relieve your pain, your doctor will advise you about other treatment options.