Facet Joint Injection Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm

Facet joint injection It is important that before you agree to treatment you are aware of the potential benefits and the side effects or complications. Please read this information all the way through.

Why has a facet joint injection been suggested? The facet joints are part of the bony spine. A combination of your hospital records and Pain Clinic assessment has shown that the pain you experience involves the facet joints. You may have noticed that when a particular area of your spine is palpated (pressed) it is very tender. Often, turning from side to side or bending backwards can cause you pain. The pain may also involve other areas of your body. Injecting the facet joints with a local anaesthetic and anti-inflammatory drug (steroid) can be helpful.

What is a facet joint injection? A facet joint injection is a combination of a steroid and local anaesthetic which is injected into the facet joint and the surrounding area. In order to ensure the injection is being performed in the correct place, the procedure is performed under X-ray control. The area around the facet joint may also be injected so that the nerves that supply that joint can be numbed which could also help to relieve your pain.

Can anyone have a facet joint injection? Most people can have a facet joint injection. However, if you are female and below the age of 55 you will be asked about the date of your period. If it was more than 28 days ago you will be asked whether you are likely to be pregnant. Although the amount of radiation used is small, there is always a risk to the foetus. Occasionally we may need to ask you to have a 2 | PI_0614_04 Facet joint injection

pregnancy test. If you have any localised infection, such as a boil on your back or a generalised infection, the procedure would not be performed until the infection has cleared up.

How effective is the treatment? For many people these injections result in noticeable improvements in symptoms but they don’t work for everybody. Unfortunately this cannot be predicted. The effects can last for weeks, months or even years. Injections may be repeated if symptoms return.

The risks associated with facet joint injections are small A local anaesthetic agent is injected into the joint. The dose is below the maximum recommended dose. If you require a number of injections, we would inject a safe amount in one visit and perhaps arrange for you to return to have more injections (if required) at a later date. High doses of steroid (anti-inflammatory drugs) can cause health problems but we restrict the amount used ensuring that the dose is well within safe limits. There is a small risk of blocking the nerves that leave the spine behind the facets within the lumbar area. These nerves transmit messages (including pain and sensation) to the legs. An injection into these nerves can cause temporary weakness, however, this is infrequent. All risks associated with the procedure will be discussed with you by your pain consultant prior to your procedure.

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What is the procedure for the injection? A cervical facet joint injection is an injection into your neck (cervical spine). You will be admitted to Ambulatory Care (day ward). Once admitted you will be escorted to the theatre where the procedure will be performed. It is a normal precaution to insert a small tube into a vein in your arm which will be removed after the procedure. Once inside the theatre you will be asked to lie face-up with your head gently extended over a pillow. Following the procedure you will be taken to the recovery area where you will be monitored before being transferred back to Ambulatory Care. All other facet joint injections are performed with the patient lying face-down on the imaging table. The doctor will be guided by the X-ray machine to check the position of the needle before administering the medication. When the injection is being given, the doctor may ask if the pain is in the same place as the pain you normally feel. If it is, this is a good sign that the injection is in the right place.

Can I have sedation? Sedation means using a drug to make you sleep during the procedure. We prefer not to use sedation for two reasons: 1. Sedation means that it will take longer for you to recover and you will require close observation for a longer period of time 2. You will not be able to respond to questions asked during the procedure if sedated

Pre-procedural education You may be required to attend an education session before undergoing your procedure. During this session you will be advised on what to expect on the day and the potential risks and benefits of the procedure. You will also be given 4 | PI_0614_04 Facet joint injection

an overview of pain management including pacing, flare-up management and goal setting. At this session you will also have the opportunity to ask questions. As you are aware, these procedures are not a cure for your pain. They are performed in order to reduce pain, maintain or improve function and in some cases provides a window of opportunity for people to start physiotherapy. If you are booked onto an education session and you fail to attend, you will not be offered the procedure as previously planned.

Medication Please take all your prescribed medications as normal prior to your procedure unless you have been otherwise advised. Please bring a list of all of your current medications when you attend for your procedure.

Important information Please inform the department if you have been newly prescribed anti-coagulants (blood thinning medication), if you have a cold or persistent cough, are taking a course of antibiotics or there has been any significant change in your overall health as this may affect your procedure. Failure to do so may result in your procedure being cancelled on the day.

Can I eat before coming in? If you are required to fast prior to your procedure, this information will be provided with your appointment letter. Otherwise, you can eat and drink normally before arriving in the department. If you are a diabetic please bring along your insulin, normal PI_0614_04 Facet joint injection | 5

snacks and glucose tablets (if appropriate).

What pain might I experience after the procedure? The amount of pain experienced might become worse for a short period of time. This reaction is not dangerous and should pass. In some cases the area served by the nerve may become weak after the injection. This effect will disappear as the local anaesthetic wears off, usually within 4-6 hours.

What will happen after the injection? You will be asked to remain in the clinical area for about half an hour after the injection, during which time the nurse will check your blood pressure and pulse along with the injection site.

When can I go home? When advised by the nursing staff, you will be able to make arrangements to go home.

Why can I not drive myself home? You would not be covered by your insurance to drive a vehicle for a period of 24 hours following your procedure. This is because you may have a temporary weakness affecting the injected area, which may impair your function or ability to drive safely. Therefore, for your own well-being, we advise that you are collected by a relative or friend. Hospital transport can only be booked if there is a medical need and you meet the criteria.

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Back at home You can remove the dressing from the injection site after 24 hours. If you have any queries in relation to your care please contact the pain service nurses on 0121 371 5105 (voicemail), or nurse led appointment enquires on 0121 371 5110. For general enquires or appointments please contact the secretaries on 0121 371 5100.

Please use the space provided to write down any questions you may have and bring it with you to your next appointment.

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The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4957.

Pain Management Service 3rd Floor Nuffield House Queen Elizabeth Hospital Mindelsohn Way, Edgbaston Birmingham, B15 2TH Telephone: 0121 371 5100

PI15/0614/04 UHB/PI/0614 (Edition 4) Author: The Pain Management Team Date: August 2015 Review date: August 2017