The facet joints are small paired joints at the back of every spinal segment. They are a common source of pain, and a commonly missed one.
What is facet joint pain?
Facet joints are true synovial joints (lined, fluid-filled joints like the knee). They get arthritis like any other joint. They are also strained in whiplash and in injuries that bend the spine backward.
Facet pain does not show on imaging in a way that proves it is the source. Degeneration (joints breaking down) shows up in nearly everyone past middle age. The diagnosis is made by medial branch block.
PRP and the other orthobiologics we use for the low back and pelvis are explained on our PRP injections in St. Louis page.
What are the symptoms of facet joint pain?
- Pain on one side, worse when you lean back or twist.
- Pain that spreads into the shoulder blade (neck) or buttock and thigh (low back), but usually not past the knee.
- Stiff and sore in the morning, easing as you move, worse again by evening.
How is facet joint pain treated?
- Medial branch blocks to confirm the level and side.
- Radiofrequency ablation where blocks give clear short-term relief. This usually lasts many months.
- Physical therapy to take load off the joints.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
Can an MRI or X-ray show facet joint pain?
Facet arthritis on imaging proves nothing. That is the most important thing to understand about the diagnosis. Degenerative change in these joints shows up in the large majority of adults past middle age, including those with no back pain at all.
That is why the diagnosis is made by testing how the body responds, not by pictures. We numb the medial branch nerves that supply one joint. Then we watch whether the pain goes away for the duration of the anesthetic (as long as the numbing lasts). That is the only reliable test. It has to work twice before anything longer-lasting is offered.
Does facet joint pain go away?
Untreated facet pain tends to linger and come and go, not clear up. That is because the joint degeneration underneath does not reverse. What changes is how much of the pain you notice.
Radiofrequency ablation usually gives six to twelve months per treatment. The nerves grow back, so it can be repeated over years. Patients often assume the first ablation is a permanent fix. Then they are let down when the pain returns. Seeing it as a repeatable treatment, not a cure, sets the right expectations.
When this becomes urgent
Facet pain itself is not dangerous. What needs urgent review is fever with back pain, unexplained weight loss, night pain that wakes you, or any new neurological deficit (new weakness, numbness or other nerve loss). Facet arthritis causes none of these.
Common questions
Why do I need two blocks before ablation?
Because a single positive block has a meaningful false-positive rate. It can look positive when that joint is not the source. Confirming twice before a longer-lasting procedure is the standard for good reason.
There is more on this in Facet Arthropathy — What It Means.
Where do you feel facet joint pain?
Usually on one side, and it gets worse when you lean backward or twist. From the neck it can spread into the shoulder blade. From the low back it spreads into the buttock and thigh, but usually not past the knee. It is usually stiff and sore in the morning. It eases once you get moving and builds again by evening.
How is facet joint pain diagnosed?
Not from a scan. Wear in these joints shows up on imaging in most adults past middle age, including people with no back pain at all. The diagnosis is made with a medial branch block. We numb the small nerves that supply one joint. Then we see whether the pain goes away while the numbing lasts. It has to work twice before anything longer-lasting is offered.
How long does radiofrequency ablation last for facet joint pain?
Usually six to twelve months per treatment. The treated nerves grow back, so the pain can return, and the ablation can be repeated over years. Many patients expect the first ablation to be a permanent fix and are disappointed when the pain comes back. Seeing it as a repeatable treatment, not a cure, sets the right expectations from the start.
Is facet joint pain dangerous?
No. Facet pain is painful but not dangerous. What does need urgent review is back pain with a fever, unexplained weight loss, night pain that wakes you up, or any new weakness, numbness or other nerve problem. Facet arthritis does not cause any of those. If they appear, something else needs to be checked.
Sources
- Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional anesthesia and pain medicine, 2020. PubMed 32245841
- Du R et al. Facet Joint Syndrome: Pathophysiology, Diagnosis, and Treatment. Journal of pain research, 2022. PubMed 36474960
- Manchikanti L et al. Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines Facet Joint Interventions 2020 Guidelines. Pain physician, 2020. PubMed 32503359
- Han CS et al. Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review. EClinicalMedicine, 2023. PubMed 37096189
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.