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Had Facet Joint injections today, would like some feedback on this plz

blackberrybunnybblackberrybunny Posts: 157
edited 06/11/2012 - 8:42 AM in Pain Management
I'll just get down to it to avoid a lengthy story. After a Discogram came out positive for 2 leaking discs in my lowest lumbar, I went a whole year after that considering the double spinal fusion surgery I need. But I am only 41 and overweight. So I talked to my pain mgmt dr. last week, asking what else can we try? He says let's try a facet joint injection.
My doctor is Chinese and very smart, Harvard educated, but we have a communications problem apparently. Mom and I both understood that I was to have my left side injected today and then come back in a week and have the other side injected. Well, the facet joint injections were so painful I couldn't hardly take it. He asked if I wanted to do the other side today, and I said NO NO NO! And then he came into the recovery room to explain to me the pain diary sheet he wants me to keep up with today.

Where we misunderstood apparently is that I had to have BOTH sides done AT THE SAME TIME, which now means next week when I go back, I have to endure this pain AGAIN and on the other side as well? Does this sound right?

I thought what was a simple procedure to inject lidocaine and a time released cortisone into the facet joints was the whole point, to try to help with my pain I've been having after my 2 discs tore open and leaked over a year ago.

I have been so upset all day thinking I have to go through all of this again. It was so painful. He said this is a diagnostic test, and he tried to explain to me, but I don't understand. Can someone help me understand this please?

Thanks so much. The lidocaine is wearing off and I am starting to hurt. How much pain can I expect? Who knows?! ~Molly


  • It would be good to ice the area after the injections that may help with pain at the injection site. I recently had facet joint injections and an epidural and I took my own pain medication before as well as a sedative. I do deep breathing during the injections. I had 2 Pain Management Drs before this last one and I'm sticking with her because I barely felt any pain. I had both sides injected. This 3rd PM Dr. I barely felt any pain only discomfort but the other 2 Drs I felt more pain maybe because my back was maybe more swollen but the injections have helped me. I return again next month for more. Best wishes I hope you have some relief after icing and if you take pain meds I would take them as ordered. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I haven't had facet joints, but just had my 3rd epidural steroid. This one was very painful.

    But overall they have reduced my pain.

    Can you ask for sedation for the next one?

    This link might help:

  • Thanks for that link, Happymom, that helped explain to me that these injetions were NOT steroidal like I thought, but only lidocaine, and it is a diagnostic test to see what is causing the pain.

    So I was really misunderstanding my doctor, or his PA, or somewhere alone the line that these injections were NOT supposed to provide me with long term relief, but to see what might be the cause of the pain.

    This was much worse than the discogram was for me. The discogram I had required only 3 injection sites in my back, and this test, because I have 2 torn discs, requires EIGHT injection sites. It hurt terribly and I do not think I can go back to have it all done again. The pain was too much. I couldn't take but one side and he asked if I wanted to quit and I said yes. I thought he meant for me to come back the following week for the other side to be done, but I misunderstood. Now I have to do it all over again. I didn't understand both sides had to be done at one time. I am very disappointed and depressed and disgusted with the whole thing.
  • It's possible to receive a facet joint injection with steroids in it. I have received that type of injection before and they can provide more than a couple of hours of relief. Talk to your Doctor.

  • Hi Dave, thanks for your response. As soon as the lidocaine wore off after a couple of hours, I was right back to where the pain level was at a 7 again. Do you think this means the facet joint injection did not work?

    I am hurting right in the middle of my spine, where the discs have annular tears.... the pain is on either side, but it radiates from the middle. I don't think my facet joints were the problem to begin with. I'm not even sure WHY my doctor did this test, since the discogram came out double positive anyways. I guess he's just trying to figure out why I am still hurting after a whole year? Isn't this nornal though with two torn and leaking discs ? (L4-L5 and L5-S1).

    I figure I am having disc pain. I don't know. Any more ideas are greatly appreciated though! I'm in a lot of pain again today.
  • Are you sure he didn't inject steroid? Because I get steriod injections and it takes a full 5 days or so for it to start "kicking in." Up until then, it's actually worse.

    If the lidocaine made a big difference, wouldn't that mean the diagnostic came out positive for that location?

    I think you REALLY need to discuss this with your doctor!
  • Hello again, HappyHBMom! Thank you again for your time to reply.

    You asked, "If the lidocaine made a big difference, wouldn't that mean the diagnostic came out positive for that location?" HappyMom, I am not sure!! Here is a pasted part from the link you gave me---what do you think it means? My pain increased as the hours went on....Here is what the article stated: What is your take on it? When you have the time....?

    "These injections eliminate pain temporarily by filling the facet joint with an anesthetic medication that numbs the facet joint, the ligaments, and joint capsule around the facet joint. If the facet joint is injected and your pain goes away for several hours, then it is very likely that the joint is causing your pain."

    I really don't know WHAT he injected me with, but I DID hear him ask the nurse for the lidocaine, but I don't know if that was for the first initial prick of the needle, and the I suppose he inserts some sort of catheter needle in? Or maybe the initial needle is a catheter kind? Because as I read it and understood it, he has to inject a dye, so he can see exactly where to make the injection into the joint. And when he injected the joints, it felt like this pressure in there, this bad pressure and weird pain.....
  • Why not call and ask those questions? I am betting the nurse could answer.

    If he's a competent physician, there is likely a reason he feels like has to do the whole thing over again. Seems like you could ask that question too :)

    When I get my ESI, he injects lidocaine in the skin only. Then the needle with the catheter, the fluoroscopic dye, then the steroid. The dye hurts, and the steroid hurts worse- just because they have to push a volume of fluid in and it puts additional pressure on the nerves.

    But I actually have a pretty high pain tolerance, so I'm assuming it's different for others in terms of how they tolerate it.

    I just think you should feel like you can ask them these questions. Can you make an appt. for an office visit to go over all of it with him?

    The thing I sent seemed to be about lidocaine facet injections. But he could have done steroids too. You really need to ask.
  • Thanks again, Happymom. The thing is, he is great at what he does---he is Harvard educated, but he is also Chinese, and has a very strong accent and a strange humor. Mom and I *DID* have a meeting with him last week, and we both *thought* we understood what he was going to do, but we had a breakdown of communication along the way somewhere.

    Ahhh, so first it's a needle to numb the skin and THEN a catheter needle? I could certainly feel the pressure of something being pushed into there. It even hurt when he pulled the needles out. And on the x-ray monitor, I could see what looked like the needles, but they were kind curved and one was almost s shaped and I thought, is THAT the needle? Are they THAT flexible? Or what WAS that? Maybe it was the dye? Gosh, this is scary. Well, you sure have answered a lot of my questions. Thank you.

    I will call and ask to speak to his P.A., who is the guy I see every month anyways--maybe he will have a little time later to give me a call back and answer my questions. Thanks a bunch for your time, happymom! PS---love your happy username! ;-D
  • So guess what I am scheduled for next week? LOL!

    My doctor said he'd do a facet block first, and if I had releif then he'd redo it with a longer acting drug.
  • I was simply walking through my house yesterday, normal pace, not beding over or anything, when suddenly I felt something pop or rip or scrape or rub or something IN THERE in that facet joint he injected, one of the 4. I don't know what it was, like a hitch. I can't describe it. It for for about 10 minutes, but by then I'd had several pain pills, so I also went to bed shortly thereafter and woke up in horrible pain today. I think after tonight I will feel better.
  • Hi Molly,

    I previously had many facet joint injections. Prior to adding unnecessary steroids, my original PM Dr did just lidocaine. When we saw that it had a positive effect, he did the steroids. These injections lead to a facet rhizotomy or nerve ablation, depending on what you want to call it. They are basically cauterizing the nerves that send pain signals to the brain with radio frequency. NONE of these procedures were pleasant. In fact they were almost intolerably painful. And I refused to do the rhizotomy without some type of sedation. They gave me Versed through an IV.

    Unfortunately, my nerves grew back and the facet injections no longer worked. I am almost 5 months out from fusion at L4/5. I really wish you the best with your DR, sounds like he knows what he is doing, he needs to find a better way to convey that to you.

    Best Wishes,

  • I just had my facet blocks today- he did the anesthetic only, as I've already maxed out on the steriods with my ESIs. I had 3 and they weren't bad at all, I actually kind of dozed off at the end.

    But I only had one side done. I don't understand the needing to do both sides at once. He is using this as diagnostic for a radiofrequency ablation.

    Did you ever talk to your doctor again?
  • Not yet--- next office visit is next Wednesday. Gotta look up this radiofrequency ablation you mention!
  • Hi Tracee,
    Sorry to hear of your troubles, ugh! I really hate to hear when a procedure is painful. Versed through an IV? HA! I laugh because it takes an elephant dose for me, and he wont' give it to me. When I had my discogram done, he gave me Versed through an IV and my BP and heart rate was so high they had to keep giving me more and more, at least 4 more times, and it was not helping, and believe me, I remember every horrid part of it. The Versed DID NOT make me forget a thing.

    This rhizowhateverectomy you guys mention, forget it! I already know I need the fusion. My facet joints are not hurting me, it's the discs. I think like many of you have suggested, perhaps my discs have been innervated. Is that the right word? Where the nerves grow into the disc?

    You guys are great. ;-)
  • Hi "BBB"
    I am a naughty member from the UK who has only just logged in for the first time in almost a year!!
    I am suposed to have facet join tinjections three times a year but only seem to get them twice a year if I am lucky!! Normally I have have it done on between 5 & 7 levels on both sides at the same time and this is normally linked in with ganglion nerve blocks and and ESI - I don't think there is a reason why you shuldn't have both sides done at the same time - possibly apart from the pain!! I like some of the others seem to have a fairly high pain threshold and I can sometimes have the whole lot done without any type of sedation - I am no hero nor do I enjoy pain -but I find it interesting to see what is going on and ask questions. I tend to have a mixture of pain medication and steriods, one fast acting and the other is almost slow release for a longer "action" most of mine tend to wear off in between 5 -7 weeks, can be longer and certainly can be shorter. There are huge differences between treatments (& timescales) between the USA & the UK and unfortunately we also have different names for similar types of drug etc, which still confuses me on here.
    I hope something starts to work for you soon!!
  • Hi Dorset Boy,
    Thanks for your time and reply! I wanted to let you know that my dr. and I had a meeting and he said that because I didn't have any relief from the FJI's that they were not for me. We kind of knew that already, it's just I was hurting so bad we wanted to try anything! So I'm off the hook as far as FJI's or any other injections go. My dr. told me to just stay on my pain meds and try to lose some weight. That's about it. Keep living until the pain is so severe I am ready to try the last resort---the dreaded multi level lumbar fusion!!
  • Why do you dread the multi level fusion??
    I know it is really scary thought at first but after mine I was great & off my pain meds quite quickly and back to work within 2 months part time to begin with, my problems arose again after a fall about 10 months down the line. I now know that no one will operate on my spine again unless it is an emergency and the best I might get is an operation to release the sciatic nerves, but atleast this would be something. I must update my profile as I have had my meds upped today and I am starting lyrica tonight!!
    Speak to you soon
  • Dorset Boy, I haven't been on all parts of this board, but you are the first person that said your multi level fusion went well! What happened after your fall? Did you break any screws or anything like that? What happened and how are you doing now??

    I've been on Lyrica for about a month now because I told my pain mgmt dr. I was experiencing this burning sensation on my skin in my lumbar area, as if someone has rubbed some icy/hot mentholatum there and it wouldn't go away. Well, the Lyrica has not made a difference yet. But they say you have to give it time. I can tell you though, and I hope you don't find this to be the same for you, that it gave me awful nightmares at first. Now I've upped my dose to 3 capsules a day, and I'm having all kinds of crazy bad dreams, but I'm determined to keep on taking it, at least another month, to see if it can help with this burning sensation.
  • I have read all the posts and realized they were made in 2009. It is 2011 and I have been to 5 Drs. (3 orthopedic and 2 neurosurgeons) in the past 3 yrs. trying to find some help for the ongoing pain in my lumbar and thoracic area's. Today the surgeon said just try the Facet Injections to see how they do and then to figure out if the pain is coming from those areas (facets) or if not, then a Rhizotomy will be indicated. I would like to know how all of you have done since 2009. If anyone reads this please let me know. Thank you!

    I had a Cervical Disectomy with 2 level fusion in 2008, and was due for a laminectomy but none of the 'other' doctors seem to think it is necessary.
  • Best wishes for your facet joint injections and hope they are effective and if so they'll do rhizotomy. I haven't had that but there are some members who've benefited from them and hope you get some relief. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Hi
    I might be able to help you with some information. I had a pain specialist who was an Anesthesiologist. He did facet injections as a diagnostic on one side only to see if that was what was bothering me. It didn't help me. A few times he did both sides at the same time; L5 through S1. He does it right in his office with a fluoroscope x-ray machine.

    I had great pain relief from the steroid facet injections after a couple of days of soreness.

    If the doctor does it WITHOUT steroids, the pain will be back in a couple of hours. This diagnostic is to see if it is the right place. If the pain relief is good you can either schedule a steroid injection, or a rhizotomy.

    The steroid injections have usually helped me. Sometimes they only help for a few days, but the best ones, I have been pain free with very little medication for 2 - 3 months!! Very good results.

    The Lyrica also did not help me at all.

    I decided to get a rhizotomy. The pain specialist said he would only do one side at a time! I did NOT want to go back twice for this. So I went to a different doctor. I saw a neurologist who referred me to a Physiatrist in his practice, and she did the Rhizotomy for me yesterday, both sides! L5-S1, L4-L5, and L3-L4.

    I started a journal here http://www.spine-health.com/forum/pain-management/journal-my-facet-rhizotomy-also-called-rfa-or-radio-frequency-ablation so you can keep up with my progress.

    The rhizotomy is done under MAC anesthesia so it is more comfortable.

    Good luck,
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