Discover Relief with Facet Joint Injection and RFA
Addressing Axial Neck & Back Pain
Axial neck and back pain refers to pain that is mainly felt in the neck or back itself, rather than shooting down the arm or leg. This type of pain is often multifactorial – it can come from muscles, discs, ligaments and the small joints of the spine.
The facet joints, in particular, can be a significant source of pain, especially with trauma (whiplash injury), age-related wear and tear or arthritis. Clues that your pain may be coming from the facet joints include a deep, localised ache close to the spine, stiffness after rest, and pain that is worse when you bend backwards, twist, or stay in one position for too long.
A careful assessment by a pain specialist is still needed to determine whether your facet joints are the main cause of your symptoms. Although clinical history and examination can help to pinpoint the facet joint as the cause of pain, the only way to confirm pain arising from the facet joint is a facet joint injection (also known as medial branch nerve block)
Facet joint pain usually comes from wear and tear of the small joints at the back of the spine. Over time, the smooth cartilage that lines these joints can thin out, and the surrounding joint capsule and ligaments can become irritated or inflamed. This is often related to age-related degeneration (spondylosis or “spinal arthritis”), previous injuries, poor posture, repetitive loading, or sometimes after spinal surgery. When the facet joints become arthritic or inflamed, they can cause a deep, aching pain close to the spine, stiffness after rest, and pain that is worse with bending backwards, twisting, or standing for long periods.
A medial branch block is a small, targeted injection of local anaesthetic placed near the tiny nerves (medial branches) that carry pain signals from the facet joints to the brain. By temporarily “switching off” these nerves, we can see whether your pain improves while the local anaesthetic is working. If your usual neck or back pain is significantly reduced after the block, this strongly suggests that the facet joints are a major source of your pain. Medial branch blocks are mainly used as a diagnostic test to help decide whether you may benefit from a longer-lasting treatment such as radiofrequency ablation (RFA).
A medial branch block is a minimally invasive procedure performed in a procedure room under X-ray (fluoroscopic) guidance. After cleaning the skin with antiseptic and numbing the area with a small amount of local anaesthetic, a fine needle is guided to the region of the medial branch nerves that supply the suspected painful facet joints. A small volume of local anaesthetic is then injected around these nerves. We typically do not use corticosteroids for this test, as the main goal is to see whether temporarily numbing the nerves reduces your usual pain. The procedure usually takes less than 30 minutes, and most patients tolerate it well with only mild, short-lived discomfort at the injection sites.
The level of pain experienced during a medial branch block is usually quite manageable. You may feel a brief sting or pinch when the local anaesthetic is injected into the skin, and some pressure or a dull ache as the needle is guided into position near the medial branch nerves. Most patients describe the procedure as uncomfortable rather than truly painful, and it typically lasts only a few minutes. Because the procedure is done under local anaesthesia, you remain awake and able to communicate with the doctor throughout. Mild soreness or bruising at the injection sites can occur afterwards, but this usually settles within a day or two.
In most cases, a medial branch block is used as a diagnostic test rather than a long-term treatment. Because the injection contains only local anaesthetic, we are mainly looking to see whether your usual neck or back pain improves while the numbing medicine is working. If you experience a clear, rapid reduction in your typical pain after the block, this strongly suggests that the facet joints supplied by those medial branch nerves are a major source of your symptoms.
When a diagnostic block is positive in this way, we will usually discuss scheduling a radiofrequency ablation (RFA) procedure to provide longer-lasting relief. RFA works by using controlled heat to disrupt the medial branch nerves so they can no longer transmit pain signals from the affected facet joints. The full benefit of RFA is not immediate – it often takes about 2 to 3 weeks after the procedure for the nerves to quieten down and for patients to notice the maximum improvement in their pain.
Medial branch radiofrequency ablation (RFA) is a minimally invasive procedure designed to give longer-lasting relief from facet joint pain. It is usually done in a procedure room under X-ray (fluoroscopic) guidance. After cleaning the skin and numbing the area with local anaesthetic, fine needles are positioned next to the medial branch nerves that were shown to be painful on your diagnostic blocks. Through these needles, a special probe delivers controlled heat to create a small lesion on the nerves. This reduces their ability to carry pain signals from the facet joints to the brain, while leaving the surrounding muscles and spinal cord untouched. The procedure typically takes less than an hour, and most patients go home the same day. Pain relief is not immediate – it often takes about 2 to 3 weeks for the treated nerves to settle down and for you to feel the full benefit.
Consult for Neck & Back Pain Relief
Dr Liu specializes in treating axial neck and back pain through precision diagnostics. If you have persistent spinal pain, a medial branch block may be used as a diagnostic tool to predict your response to radiofrequency ablation (RFA), a technique that can provide long-lasting relief by treating the nerves supplying the facet joints.
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