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Facet Joint Injections/RFA

EMS GuyEEMS Guy Posts: 916
edited 06/11/2012 - 8:57 AM in Pain Management
I had my third round of Facet Joint Injections today. Still a bit sore around the injection sites. My PM does the injections in his office with no medication given for pain. The procedure isn't comfortable, but it's over a done with in a matter of minutes.

They said I'm a candidate for RFA. I asked and they said it could be done in their office the same as the Facet Joint injections. I've read some posts on the board about folks getting Fentanyl for the procedure. Is RFA really that painful?


Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2


  • I've had two RFA procedures, three levels both times on the right side, L3-L4, L4-L5, L5-S1 (need to correct my sig line, forgot L3-L4 there). I have also had numerous steroid injections and nerve blocks (have lost count). IMO, the RFA's are more painful because it involves burning of the nerves. So, I've always opted for the conscious sedation when having RFA's. I'm just more relaxed when I know I'm not going to react to the pain as much, so I'd recommend it. The only real downside is that you have to have someone drive you home, and you can't drive for 24 hours. I've been sore enough afterwards that I've welcomed the enforced down time.
  • Good luck if you go the RFA route. It looks like my next round of searching for relief is facet injections. I'm really nervous. I can barely handle the epidural injections. I vagal every time. I've been searing and reading all about facet injections and RFA tonight. Not looking forward to it!
  • Traci - Have they considered giving you Versed before your procedure so that you don't vagal out?

    Lexigirl - With the procedure being done in his office, I don't know what medication options are on the table. I have an appointment on October 18th to discuss the procedure and a check up.

    My left side is still pretty painful today. Not from the shots, but from the same pain that caused me to have the injections to begin with. The real test will be how I feel in about 5 days (to see if cortizone is making a difference or not).
    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I had valium for my first injection and that made my BP even lower. The 2nd time the nurse said she was glad I didn't have anything in my system because my pressure was super low. Valium is all they offer unfortunately, and its only on a rare occassion from what I was told. I have a cavity that needs filled and I keep telling myself if I can get through these injections there is no reason I cant go get the cavity filled (first one ever and i'm 34...scared to death of that drill). At least the dentist offers nitrous!!!
  • I have had many RFA's. They are painful. I have had it with conscious sedation and without. You have to be conscious enough for them to be sure they have the right nerve!! I have not had much luck with them but I am always willing to try it again on a different level of my spine because you never know when it is going to work.

    Good luck!!

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • I'm four days post injection and they are not working very well at all this time. I go back to the doc on the 18th.

    This is frustrating. When I move a certain way (typically getting out of a chair) I can feel my lower back pop. I'm just wondering if an MRI would be helpful at this point or not. Since my fusion is L4-S1, I hope L3 hasn't started to go.

    This blows.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • I have heard of people who have had to have the vertebrae above and below a fusion fused because of the pressure the fusion puts on the surrounding area. I also know of people who have had only one fusion and that was it.

    My spine is so deteriorated that I was one of the ones who had more fusions.

    Ask your doctor about an MRI. They show much more than an xray.

    Good luck and keep us posted.

    L4/L5 laminectomy, L4/L5 360 fusion with instrumentation, L1 to L5 fusion, L5/S1 fusion w/ disc replacement, left and right SI joints fused.
  • 3 years post L4-5 fusion, I've totally blown out my L3-4 level and the L2-3 ain't looking so great. I really had no choice with the first fusion because I had a grade 3 spondy, severe stenosis, a massive cyst engaging my spinal column and I was having a big problem walking. So with the best of all intentions and the most optimistic outlook, here I am maybe looking at another fusion. I hope you are luckier! Get another doc's opinion if you have to and don't let anybody "poo poo" your symptoms. Isn't "poo poo" a medical term?????

    That being said, I would like to share something off topic. Moderators, take this out of this topic if you feel necessary and I won't blink an eye!

    I am a "CASA." A court appointed special advocate (strickly volunteer) for neglected and abused children removed from their homes and placed in DFCS custody. In some states we are called "guardian ad litum." My job is to stay with each child/children for at least a year after coming to the court's attention and make sure they are being treated well. Point being....I have a 14 year old child who has been mistreated and abused in every way humanly possible. The child has just been diagnosed with Ewings Sarcoma and may lose his/her leg. I am still reeling.

    If you end up having to deal with another fusion level and severe pain (as I have and I hope you don't) try your best not to focus on it. We will all support you whatever the outcome. And I am very sorry for venting. I just found out my kid's prognosis and I am very emotional. Please forgive.

    Hang in there. It ain't easy for those of us who have to deal with this back stuff and I do want you to keep us informed!!!!! We may only be able to help by listening but that's not the worst thing. K
  • Did you have the RFA's or just a steroid injection?
    I was really sore for about a week after my facet rfa, but once that soreness wore off, i felt great for a couple years.

    Let us know how you are doing.
  • Hi there,

    I had the injections done about two weeks ago. Unfortunately, they did not provide much relief this time.

    They have re-scheduled me for one more round in a couple weeks. At that point, I can't have anymore cortizone for a year. I've hit the limit. If that doesn't work, I'm not going to be in favor of doing the RFA.

    I'm not sure what will be next though if the injections don't work and I don't do the RFA. Unless I'm mistaken, if the injections don't work, then there is a good chance the RFA won't work.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Good luck with the RFA. I have heard a lot of people say they work well. I have had one, and they did it in the hospital under sedation. It was easier than the facet injections that are done in the office. Those really hurt! I have another RFA scheduled for 11/3.
  • I have facet joint degeneration T 10-11 and bilateral at T 11-12...MRI didnt show any disk or stenosis...I have had epidural steroid injections that provided almost full pain relief but only for 3 weeks...I then had the Facet nerve block done which only provided minimal relief for about a month...Finally had RFA done and on a scale of 1-10 my pain was a 10 and went to a 7...I then experienced some nerve pain and throbbing pain just above and just below where i had the RFA done...I just had a nerve block done today T 6-8 and L1-3...I hope this will take the left over nerve pain away and the throbbing pain...Although the nerve pain does hurt, my main complaint would be throbbing pain the travels up to the top of my head and down to my hip area...Good luck to everyone who is currently seeking a treatment to take your pain level down...
  • Reading all of this stuff scares the crap out of me. It sounds like they just do procedures until one maybe works.

    I'm not sold on interventional PM procedures, but I guess they help some folks tremendously. Good luck guys.
  • Yeah, well so far nothing has worked for me. I had the two RFAs, then after that had physical therapy for awhile, then acupuncture. Then I had another round of facet steroid injections. Then two weeks ago I had an injection right into the disc space.

    Everything works for a few days, then the pain comes back.

    The good thing is that they put me "out" for the procedures. But I wish to heck something would work, I hate being in pain all the time.

    Aleve helps a little.
  • Ive had many RFAs and they work well for me, unfortunately, my dumb HMO decided it's not necessary so they are now denying me the RFAs. I'm so mad about that but will get them when I dump them for another company in June, and the kicker is, I work for them and make a ton of money for them. But.....I digress.
    I've had RFA from two different doctors and always 3 cervical levels 1 side at a time about 1 month apart. The first one I think overdid the sedation as I drifted in and out. but for him, it took about 45 min. The second time and 3 other times since, the doctor used versed, and morphine and it takes about 2 1/2 hours because she is extremely careful and methodical.
    I would not be able to handle it without the drugs, it is very painful.
  • I am about to have my second round of facet joint injections next week. After that I will be scheduled for a radial ablation (spelled right?) He said it will feel like a really bad sunburn in the area for a few days. I am having it done at the hospital...I don't want to be awake at all.

    I am on oxy for pain and a muscle relaxer that I take before bedtime. I have 2 bulging discs: one at L4/L5 and L5/S1 which is the one causing the majority of my pain. My insurance denied my fusion surgery so I am left with injections and pills.

    After reading all of this, I think this is going to feel a lot worse than a sunburn!!!!

  • My RFA wasn't that bad. The first day was pretty uncomfortable, but after that things went back to normal. I have gone back to having the same old pain again though.

    The only medication I had was 5mg liquid valium right before the procedure. That was really all I needed.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • Keith, when did you have yours? How long did it last?

    My doctor is now talking about doing an epidural -- but I had one 4 years ago that didn't help.

    I'm getting really frustrated -- Injections right into the disc, RFAs, facet injections, acupuncture, physical therapy, nothing has worked.

    You guys think I should try the epidural?
  • Epidurals did not help me at all. The doctor who did it actually hit a nerve when he did it making my right leg feel like it had been cut off for a few seconds.

    The best luck I've had was with Facet joint injections. They work for about a month. But, it wears off and you can only have so much cortizone in a given period.

    I wish I could tell you better news, but I'm afraid I can't.

    I had my RFA done in mid-December. It felt pretty good for a while, but then started to go back down hill a couple months later.

    A friend of mine got a pain stimulator implanted a moth or so ago and she swears by it. I don't think I can do that. The unit buldges out of her butt cheek. She will need to get the battery replaced every five years (more surgery).

    Bottom line, I think we can all agree that back pain just plain sucks!

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
  • did you go back to work the next day? Mine is scheduled at the end of May and was just wandering if you can go back to work the next day or not.
    Also, did you get better pain meds for afterwards or the same stuff you were on before?

  • EMS Guy, that was really helpful information, thank you.

    I'm thinking of seeing another Orthepedic. Even though all of them have said it's arthritis, and there is no surgery they can do.

    My friend went to some big shot Ortho that is the doc for one of the big sports teams here; I may check him out.

    Isn't chiropractic and acupuncture supposed to help? Sometimes I feel like a hypochondriac. Pain patches seem to help most people. Not me. Everything that most people say helps doesn't help me or makes my pain worse. It is frustrating for the physical therapists too; when I just get worse.

    Sheesh, you are right, pain sucks.
  • I was back to work the next day. I was sore, but it was managable.

    Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2
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