Facet joint disease

Facet joint injections may help. They work by reducing inflammation. The injections are also used to see if radiofrequency ablation of the medial branch nerve (the one that carries pain) would be effective. Almost always the injection helps for 6 hours because of lidocaine in the injection. Then if the steroid reduces inflammation sufficiently it may take a few days and lasts up to three months--though they say as much as 6 months.
If the lidocaine helps you could consider having the nerve ablated with radiofrequency.
It is a low risk procedure and I consider it worth trying.
Sometimes there is a reaction to the prednisone which causes additional swelling and burning, sometimes not and it does go away.

Thank you for your insightful input. Is rf ablation better than injection?

Ablation lasts longer sometimes forever, though the nerves can grow back together. And you can repeat the ablation. The steriod degrades bone, but (I think even worse) degrades cartilage. Most providers want to apply the steroid first to acertain that the pain is coming from the narrowed facet. My choice would be to have ablation if the the injection works anywhere from 6 hours to six months. I wouldn't want to keep repeating the injection even if it were only every six months. I think they only allow three steroid injections in a year.

Hello @gently
Ablation has been wonderful for me. I have had this procedure three times, the last lasting for almost 10 years.
I am now have returned to Ontario, and am now receiving treatment at the Pain Clinic, which is a branch of McMaster Medical Centre. This referral due to the beginnings of a return of the back pain. To date I have received three treatments of multiple injections of Bupivacaine 0.25% and Lidocaine 2%,
However, these shots have resulted in great pain which takes about 5 days to resolve.......?!
How is this possible, that anesthetic can cause this difficulty?????
In response to this pain, my last injections were centred on the right S.I. area and down the right side of the sacrum, as well as the hips.
To fully disclose, four weeks ago, my left Achilles has flared and I am receiving 'shockwave therapy' on this -- with success!
In light of the past three months of disasters[ written of elsewhere], I am feeling utterly run over, and on the verge of throwing everything overboard [ a first for me] .... any thoughts ??
You and others have given me such hope, support and guidance before, and I am in sore need of it now.
Thank you for any comments.

Thank you for sharing. Why do you feel that you feel this way? It’s good to hear ablation can be so promising although i wonder about any side effects? I need to read more on it. And shockwave too.
Hope you are feeling better somehow …at least sometimes.

Mornin' @snowmass
Having such intense pain for the following days after this treatment was difficult and confusing. I needed others to tell me if they had experienced the same.... today it has eased greatly... more of a numb sensation.
"Shockwave therapy", I am told is a technique using electrical pulse to reduce swelling, inflammation. The 'wand' is moved over the swollen area while the blasts of electricity are discharged into the tissue.... yes, it is uncomfortable, especially when near bone... which happens on an ankle!
However, this works. My tendonitis of the Achilles is much improved... some swelling is there, but pain reduced and I can weight bear too.
Before treatment they said, "this is uncomfortable, but only lasts for 4 minutes"..! This is true! Considering the usual length of time and discomfort from Achilles tendonitis, this is good. Next appointment... next week.
I don't know of any side effects, other than less than anticipated results. I did meet one woman who had debilitating pain, who said she had the procedure every 8 months; she noted that one time she did not experience the best of pain relief, but all other times it was a "life-changer".
One thing I would ask your doctor how long they anticipate recovery and what to expect in recovery. I took about 6 weeks, but had wonderful results. Definitely worth the recovery time and initial discomfort.
I hope you too will enjoy this excellent result, and enjoy life without that pain and restriction on your life.
Thank you for your kind words. I had written my note during heavy pain and the medication fog.
Today does seem a better day., and the sun is shining!

Hi @snowmass
Just to clarify... I am talking about both procedures... the line starting "I don't know of any side effects", I am returning to ablation therapy.
The paragraph starting with "shockwave" and going to the words "next week", I am referring to the ankle treatment.
I am blaming the drugs -- but maybe its just the person!
Have a great day.

Thank you 🙂
I read twice and had understood you 🙂
You are really inspiring. I am humbled since I do not yet have as many diagnoses and no dependent other than my dad in his late 70’s. I had my first panic attack while I was driving which I am not sure if it was the lidocaine/mercaine/steroid injection for my tos diagnosis a week earlier or the harder cliff from menopause to post with estrogen level in prepuberty or the combo.
I hope you have a nice weekend and thank you for the support and sharing. It means a lot especially when you feel like you are not getting much support.

Christine, it sounds exactly like a prednisone flare. Is it possible that your injection contained more than the local anesthesia. McMaster Medical may be giving you diagnostic injections.
Are any of these injections done under fluroscopy? or are the surface in office injections.
Have you had any relief after the five days.
My right SI is a source of discomfort for me. I've had the steroid/lidocaine injections and the five day flare without any long lasting relief. The first three hours were good-- numb.
We're they going after your muscle or your joint. Was the pain equal on the right side of the sacrum and the area of the hip?
It is also possible to hit a nerve with the needle instead of next to the nerve where the procedure allows the anesthetic fluid to surround the nerve.

Hello @gently
Good to hear from you again.
In answer to you questions:
Yes, I suspect that they are doing a wide sweep of diagnostics - I think if I was still back in B.C., I would be missing this part as they have already 'known' my back.
No, there was nothing else other than the Bupivacaine and Lidocaine in the injections. First shots... very painful for 3 days, then a 'bad bruise', and stiff feeling.
On the 30th May, had a much larger number of shot [about 18], and over a large area of lumbar spine, sacral and over near hips.
That has been the worst... my Emtec-30s were not taking care of the pain.. Yes, I have wondered if hitting the nerve was the problem... originally, it was a severe event when my S.I. joint and sacrum were dislocated and fractured in the violent incident: I have wondered if my nerves have 'shifted' from the usual anatomical position. [back then, 30 years now, the doctors did not think I would walk again]. Now there is arthritis in the joint.
Yes, pain did lift after the 4-5 days - still numb and sore, but not the 'hanging by the finger nails' agony.
Last session was on 6th, and he said he was going to 'narrow' the area, and looked grim at my description ... and shot about 12 shots around the right S.I., and down the right edge of the sacrum; and 3 shots each into the hips, to "take care of that".
But as I left, leaning over my walker, [very gracefully of course!] my right leg became more numb/dead, with a strange feeling like a hard rod down the back of my leg from butt to around the knee. By the time I was home. I could hardly move my leg, and simply got into bed and stayed there. Yes, it 'lifted' from the severe pain around 16:10 in the afternoon. Today, I am still sore, but more a 'numbed-out' feeling. Again, I am taking my Emtecs and Baclofen for relief.
My pharmacist has assured me that this is not another adverse reaction to the drugs and did not venture into any speculation.
No, these are not under fluroscopy... that was what my specialist [rheumatologist] had sent me for, but this is not what I am getting presently ---- adds to the possibility of being the 'hunting down' the diagnostics.
This Thursday, the 13th, I am to get shots of Medrol instead [I assume with Lidocaine]... Steroids always have done amazing 'fixes' for me, both arthritic and lung, but now with the osteoporosis [due to over zealous steroid use], this will be the first steroid in over 6 years. [the endocrinologist appointment isn't until the 26th... so will see what she says about this]
'Going after muscle or joint'... no, I was told they were going after the nerve [think they found it!] No, the main pain was nearer the right S.I. and far more severe than the hips which felt more like bursitis.
Sorry to hear of your S.I. problems... we so hope for the best with these attempts at pain control, and are so often disappointed.
The issue on the horizon, which I try not to reflect on, is that there seems to be little that can be done to actually fix the problem. 'Fusing' or 'gluing' the joint together does not seem to be an option! We are left hoping that one of these regimes will be of help.
There are two things that could help, but are not likely...
Remembering back to the 'good old days' of 'admitting to hospital for tests'; then all of the specialists were present at morning rounds, and knew the course of diagnostics and the treatment suggestions/results and all could evaluate in the moment. When there is a complicated picture, this would be so much more efficient and safe.
Recovering under observation in hospital would assist in a full and accurate picture being arrived at, as well as,
appropriate care given to the 'victim'.
I am always astonished at the power of the nervous system. I would never appreciate the strength of the pain potential from this intricate system unless I had experienced it.
I do hope you are having a better day today.
Thank you for the input.
christine