Facet Joint Pain: How It's Diagnosed and How It's Treated
Facet joint pain is one of the most common — and most commonly overlooked — causes of chronic neck and back pain. I estimate that 30–40% of my patients with chronic back pain have a significant facet component, yet many have never been evaluated or treated specifically for it.
What Are the Facet Joints?
Each level of the spine has two facet joints — small joints located on the back of the vertebrae that allow controlled movement (bending, twisting) while providing stability. Like any joint, facet joints can develop osteoarthritis, become inflamed after injury, or degenerate with age.
The clinical result is chronic neck or back pain that has characteristic features — but it's often misattributed to "muscle pain" or disc problems.
Recognizing Facet Pain
Facet pain tends to:
- Be worse with extension (bending backward) or rotation
- Cause local tenderness directly over the spine
- Refer to the buttocks or upper thighs (lumbar) or the shoulder and occiput (cervical) — but typically NOT below the knee or below the elbow
- Worsen with prolonged standing or sitting and improve with walking or changing positions
- Be associated with facet hypertrophy on MRI or CT
If this pattern sounds familiar, facet-mediated pain is likely contributing.
How We Diagnose Facet Pain
The only reliable way to diagnose facet pain is with medial branch blocks — small injections of local anesthetic adjacent to the nerves that carry pain from the facet joints. If your pain decreases by 50% or more after the block, that confirms the facet joints as a significant pain source.
MRI and X-ray findings alone are not reliable — many people with significant facet arthritis on imaging have no pain, and vice versa.
The standard protocol requires two positive medial branch blocks (on separate visits) before proceeding to radiofrequency ablation.
The Treatment Pathway
Step 1: Diagnostic medial branch blocks Confirm facet-mediated pain.
Step 2: Facet joint injections or repeat MBBs Second diagnostic block confirms the finding.
Step 3: Radiofrequency ablation If both blocks are positive, radiofrequency ablation of the medial branch nerves provides relief lasting 12–18 months. This procedure heats the nerve to create a small lesion, disabling its ability to transmit pain signals from the joint.
When the nerve regenerates (which takes 12–18+ months), the procedure can be repeated with equivalent results.
Why This Pathway Matters
Unfortunately, many patients receive steroid injections into the facet joints or nonspecific back injections without proper diagnostic confirmation — and wonder why they don't get lasting relief. Following the proper diagnostic-to-treatment pathway ensures that the right target is being treated.
If you have chronic neck or back pain that hasn't responded to typical treatments, call 516-492-3100 — facet-mediated pain may be the missing diagnosis.