There are numerous structures in your spine that can cause lower back and/or leg pain. The facet joints are a frequent cause of lower back pain. They are highly innervated with little nerves whose sole job is to provide sensation from them. These are the joints in your spine that allow you to twist and bend forward, backward and sideways. They take a lot of stress and loading over the course of our lives. They may become arthritic enough so that we can even see the degeneration on X-rays or MRI. However, many times we cannot see an abnormality on radiographic studies, although we still believe that these joints are generating all or some of your lower back and/or leg pain. Chronic pain from the facet joints really serves no purpose except to detract from your quality of life. The only way to find out if the facet joints are the source of your pain is to perform a diagnostic facet block. This is a diagnostic block because you will either feel better, meaning that these joints are responsible for your pain, or you won't feel better, meaning that these joints are not generating your pain and we must look elsewhere for causes. You will be sent home with a "pain diary" to record how you are feeling after the block. Remember this is only temporary relief that may last hours to a few days. If it appears that you obtained adequate relief from this block, we will consider the next step, which is RF (radiofrequency) ablation of these same nerves. We will discuss this procedure with you separately. Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.
As with most procedures, there is a remote risk of bleeding, infection, nerve injury or allergic reactions to the medications we use. Some short-term effects may occur, as well. For example, if the numbing medicine spreads to a nearby nerve root, part of your leg might feel numb for a few hours. In addition, the injection may cause some soreness in your back. Using an ice pack should help. You also may take your usual pain medicines.
After checking in and signing a consent form, you will be taken to a procedure room. Please wear loose-fitting clothing. You may be asked to change into a hospital gown. Our nursing staff will position you on your stomach on a narrow table. We do not usually use IV medications/sedatives because they can interfere with the interpretation of the block results. Your back will be cleaned with iodine and sterilely draped. Next, the doctor will use an X-ray machine (fluoroscope) to guide the needles into the correct spots. He will numb your skin first with a small needle, which will sting just a bit. It is very important to hold still and let us know if we are causing you discomfort. We usually block three joints on each side (six total) through four separate needles by injecting a small amount of local anesthetic at each site. The whole procedure will last 10 to 15 minutes.
You will be taken to the recovery room in a wheelchair and discharged home shortly thereafter. It is very important for you to complete the pain diary as accurately as you can. We want to know how your usual pain responded to the blocks. You are encouraged to be as active as you can be, to "test" the back. Remember, we are not really masking anything, so you will not hurt yourself. You may have some local tenderness from the needles, which ice may help relieve. In addition, you can take your normal pain medicines.
Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing.
You should call us immediately at 781-744-5090 if you experience any of the following: