If your back hurts more when you stand, arch backwards, or twist and scans do not show a clear problem, your pain may be coming from the facet joints which are the small spinal joints at the back of the vertebrae. This blog explains what facet joint injections really do, how they differ from medial branch blocks, and when longer-lasting treatments like radiofrequency ablation may be needed.
Facet joint pain can cause local back ache and referred pain to the buttock or hip.
What are Facet Joint Injections (and How do they Differ from Medial Branch Blocks)?
A facet joint injection involves placing anti-inflammatory medicine, often with a local anaesthetic, directly into or near the joint. This can provide short-term pain relief by calming inflammation and reducing stiffness. Patients often ask: “Will this fix the arthritis?” The answer is no. Injections are a tool to relieve symptoms; to allow you get fitter and stronger and get the joints moving again, not cure arthritis in the spine.
A medial branch block works differently. It targets the tiny nerves that supply the facet joints. Instead of treating inflammation, the block tests whether the joints are the actual pain source. If your pain eases while the anaesthetic is active, it strongly suggests the facet joints are responsible.
Facet joint injections reduce inflammation for short-term relief.
Medial branch blocks test whether the facet joints are causing pain.
Do Injections Cure Arthritis in the Spine?
No. Facet joint injections do not cure arthritis. The joints can become stiff, inflamed, or worn with age, a condition often called facet arthropathy or facet syndrome. An injection can reduce irritation and settle a flare-up, but it cannot reverse the underlying wear and tear.
The real value of injections is in helping people move better, sleep more comfortably, and reduce medication use while longer-term strategies are planned. This might include targeted physiotherapy to restore spinal stability or, if confirmed by diagnostic blocks, radiofrequency ablation for more durable results.
How Injections are Used to Confirm Facet Joint Pain
One of the biggest challenges in back pain is that imaging does not always match symptoms. Some people have severe arthritis on MRI with no pain, while others have disabling pain and normal scans. This mismatch is why facet joint pain is often misdiagnosed.
A diagnostic medial branch block helps solve this problem. Under live X-ray guidance, a tiny amount of anaesthetic is placed on the medial branch nerves that carry pain from the facet joints. If pain eases during the block, it confirms the joints are the source. This test is sometimes repeated to be sure before moving to longer-lasting treatments such as radiofrequency neurotomy.
Facet Injections vs Medial Branch Blocks vs Radiofrequency
Facet Injections
Facet injections place steroid and anaesthetic into or near the joint. They are most useful for short-term relief during a flare-up or as a bridge while other treatments are introduced.
Medial Branch Blocks
Medial branch blocks are diagnostic injections. They numb the nerves supplying the facet joints to confirm whether the joints are responsible for pain. Relief is temporary, usually hours to days, but the information gained is crucial.
Radiofrequency Ablation (Neurotomy)
When medial branch blocks confirm the joints as the pain source, radiofrequency ablation can provide longer-lasting relief. Using controlled heat, it switches off the pain-carrying nerves. Relief often lasts 6 to 18 months and the procedure can be safely repeated if pain returns.
Who Should Perform the Procedure - Radiologist or Pain Specialist?
Both radiologists and pain specialists can perform facet injections and medial branch blocks, but their roles differ.
Radiologists can do procedures. They are experts in using imaging such as CT or X-ray to guide needles precisely. Their focus is the technical procedure, and they usually follow the scan rather than a detailed history or physical examination.
Pain specialists combine the procedure with a whole-patient approach. They take a full history, perform a physical exam, review scans, and decide if/when injections are appropriate. If blocks confirm facet pain, they can also guide the next steps such as radiofrequency, physiotherapy, or advanced options like multifidus stimulation.
In short:
Radiologists follow the scan.
Pain specialists follow the history, examination, and scan together. This ensures the procedure is not only technically accurate but also part of a comprehensive treatment plan.
Recovery, Risks, and Medicare in Melbourne
Facet joint injections and radiofrequency ablation are considered low-risk procedures when done under X-ray guidance by trained specialists. Possible side effects include mild bruising, temporary soreness at the injection site, or short-lived numbness. Serious complications are rare.
Most people can return to light activity the same day and normal activity within 24 to 48 hours. Radiofrequency ablation may cause a short flare of soreness before longer-term relief sets in.
In Australia, both procedures require a referral from your GP or other treating specialist . Medicare rebates are available when they are performed by qualified pain specialists in accredited facilities, including private hospitals across Melbourne. Your specialist will discuss risks, benefits, and alternatives in detail so that you have the chance to ask questions and feel fully informed before treatment.
When to Consider Other Options Like Radiofrequency or Multifidus Stimulation
If short-term injections and physiotherapy do not provide enough relief, or if medial branch blocks confirm the facet joints as the cause, radiofrequency ablation is usually the next step.
For people with persistent, debilitating back pain where muscle dysfunction is also contributing, newer treatments such as restorative multifidus muscle stimulation may be considered. This therapy helps reactivate the deep stabilising muscles of the spine, addressing one of the underlying causes of mechanical back pain.
Book Facet Joint Pain Treatment in Melbourne
If you are living with chronic back or neck pain that worsens with standing, arching, or twisting, your pain may be coming from the facet joints.
Speak with your GP or other treating specialist about a referral to Pain Specialists Australia. Our team performs precise medial branch blocks and radiofrequency ablation in accredited Melbourne hospitals, as part of a full treatment pathway that also includes physiotherapy, psychology, and dietetics.
With advanced diagnostics and targeted treatments, we help people across Melbourne reduce pain, improve movement, and return to living with confidence.
Frequently Asked Questions about Facet Joint Injections and Radiofrequency
1. Do facet joint injections actually work?
Yes, as long as the diagnosis is correct. Facet joint injections can reduce pain for a short period of time, especially during a flare-up. They work by calming inflammation inside or near the joint. However, they are not a cure for arthritis in the spine and are usually used as part of a stepwise pathway that may also include physiotherapy, medial branch blocks, or radiofrequency ablation. Their role is to provide relief while guiding the next steps in a broader treatment plan.
2. How long does pain relief last after a facet joint injection?
Relief from a facet joint injection can last from a few days to a few weeks. Some people experience only short-term benefit, while others notice improvement for several months or longer. If injections provide relief but the pain returns, your pain specialist may recommend radiofrequency ablation for longer-lasting results. The duration of relief can also depend on the level of joint irritation and whether lifestyle changes are introduced alongside the procedure.
3. What is the difference between a facet joint injection and a medial branch block?
A facet joint injection places medicine directly into or near the joint to calm inflammation. A medial branch block targets the tiny nerves outside the joint with a small dose of anaesthetic to test whether the joint is the true source of pain. Relief from a medial branch block is temporary, but it provides valuable diagnostic information that guides further treatment such as radiofrequency ablation. Both procedures are performed under live X-ray guidance to ensure accuracy and safety.
4. How successful is radiofrequency ablation for facet joint pain?
Radiofrequency ablation can provide pain relief for 6 to 18 months by switching off the nerves that carry pain from the facet joints. Some people report longer benefit, and the procedure can be repeated safely if pain returns. Success rates vary, but the best results are seen when medial branch blocks confirm the facet joints as the pain source before radiofrequency is performed. Patients who combine the procedure with physiotherapy and activity modification often achieve the most durable outcomes.
5. What are the risks of facet joint injections and radiofrequency ablation?
Both procedures are considered low risk when performed under X-ray guidance by specialists. Possible side effects include temporary soreness, mild bruising, or short-lived numbness near the injection site. Radiofrequency may cause a brief increase in discomfort before pain improves. Serious complications are very rare. Your pain specialist will discuss risks, benefits, and alternatives so you have all the information you need. Having this discussion helps you make an informed decision and ensures the procedure aligns with your goals.
6. How long is the recovery after facet joint injections or radiofrequency?
Most people return to normal daily activities within 24 to 48 hours. Light activity such as walking is encouraged, but heavy lifting or strenuous exercise may be avoided for a short period. Radiofrequency ablation may cause some temporary soreness before the longer-term relief develops. Many patients find that their ability to stand, walk, or sleep improves once the early soreness has settled.
7. Do I need a referral for facet joint injections in Melbourne?
Yes. In Australia a referral is required to see a pain specialist for facet joint injections or radiofrequency ablation. This ensures you receive a coordinated care plan and can access Medicare rebates where eligible. It also allows your GP and specialist to work together so your care remains safe and well-integrated.
This is not true. Many people with normal scans still have pain from the facet joints. Imaging can show arthritis that does not hurt, and sometimes it misses painful joints completely. That is why diagnostic medial branch blocks are the most reliable way to confirm if facet joints are the pain source.
Common Misconceptions About Facet Joint Injections and Radiofrequency
“My MRI is normal, so it cannot be the facet joints”
This is not true. Many people with normal scans still have pain from the facet joints. Imaging can show arthritis that does not hurt, and sometimes it misses painful joints completely. That is why diagnostic medial branch blocks are the most reliable way to confirm if facet joints are the pain source.
“Facet injections cure arthritis in the spine”
Facet joint injections do not cure arthritis. They reduce inflammation and provide relief, but they do not reverse the underlying changes in the joints. Their purpose is to help manage pain while other long-term strategies such as physiotherapy or radiofrequency ablation are planned.
“Radiofrequency burns the spinal cord”
Radiofrequency ablation does not burn the spinal cord. It works by applying controlled heat to the tiny medial branch nerves outside the spinal canal. These nerves carry pain signals from the facet joints and turning them off can provide longer-lasting relief without affecting the spinal cord.
“It must be sciatica because I have leg pain”
Facet joint pain can spread into the buttock, groin, or thigh and sometimes feels like sciatica. True sciatica comes from irritation of a spinal nerve and usually includes sharp shooting pain, tingling, or numbness down the leg. A specialist assessment can tell the difference and make sure you get the right treatment.
“If physiotherapy hurt once, it will always make it worse”
It is common for some exercises to cause discomfort when you first start, especially if your back is stiff and sore. With the right guidance, physiotherapy focuses on safe, controlled movement that helps stabilise the spine and reduce strain on the facet joints. Many people find their pain improves and flare-ups reduce when the right program is followed.
READY FOR RELIEF?
References
Further Reading and References on Facet Joint Injections:
1. Bogduk N. International Spinal Injection Society guidelines for the performance of spinal injection procedures. Pain Med. 2004;5(2):124-126.
- Covers international guidelines for facet joint injections, medial branch blocks, and radiofrequency neurotomy. These guidelines remain the foundation for safe, evidence-based spinal injection practice worldwide.
https://pubmed.ncbi.nlm.nih.gov/9430809/
2. Boswell MV, Manchikanti L, Kaye AD, Bakshi S, Gharibo CG, Gupta S, Jha SS, Nampiaparampil DE, Simopoulos TT, Hirsch JA. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain. Pain Physician. 2015 Jul-Aug;18(4):E497-533.
- Systematic appraisal of the evidence on facet joint injections for chronic spinal pain. Concludes that while injections have limited long-term benefit, they remain valuable as diagnostic tools to identify facet-mediated pain.
https://pubmed.ncbi.nlm.nih.gov/26218947/
3. Manchikanti L, Hirsch JA, Falco FJ, Boswell MV. Management of lumbar zygapophysial (facet) joint pain. World J Orthop. 2016 May 18;7(5):315-37.
- Comprehensive review of strategies for managing lumbar facet joint pain. Discusses diagnosis, conservative care, injections, and radiofrequency ablation, highlighting the importance of a stepwise, evidence-based approach.
https://pubmed.ncbi.nlm.nih.gov/27190760/
4. Smuck M, Crisostomo RA, Trivedi K, Agrawal D. Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review. PM R. 2012 Sep;4(9):686-92. doi: 10.1016/j.pmrj.2012.06.007. PMID: 22980421.
- Systematic review on the effectiveness and repeatability of radiofrequency neurotomy. It confirms that many patients gain relief from repeat procedures once nerves regrow and pain returns.
https://pubmed.ncbi.nlm.nih.gov/22980421/
5. MacVicar J, Borowczyk JM, MacVicar AM, et al. Cervical medial branch radiofrequency neurotomy in New Zealand. Pain Med. 2012;13(5):647-654.
- Demonstrates safety and outcomes of cervical medial branch radiofrequency ablation. This study provides reassurance that radiofrequency is effective and safe when used in the neck for confirmed facet joint pain.
https://pubmed.ncbi.nlm.nih.gov/22458772/
6. Maas ET, Ostelo RW, Niemisto L, et al. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev. 2015;10:CD008572.
- Cochrane review evaluating the effectiveness of radiofrequency ablation for chronic back pain. It highlights both the potential for pain reduction and the importance of selecting patients carefully through diagnostic blocks. They called for further studies.
https://pubmed.ncbi.nlm.nih.gov/26495910/
7. Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine. 2000;25(10):1270-1277.
- Seminal study establishing efficacy of radiofrequency neurotomy in lumbar facet pain. It remains one of the most cited trials showing how carefully selected patients can achieve long-term relief.
https://pubmed.ncbi.nlm.nih.gov/10806505/
8. Juch JNS, Maas ET, Ostelo RW, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the Mint Randomized Clinical Trials. JAMA. 2017;318(1):68-81.
- Large multicentre RCT assessing radiofrequency denervation for chronic low back pain. Found mixed results, showing that outcomes depend on strict patient selection with diagnostic medial branch blocks.
https://pubmed.ncbi.nlm.nih.gov/28672319/
9. Engel A, King W, MacVicar J. The effectiveness and risks of fluoroscopically guided cervical medial branch thermal radiofrequency neurotomy: a systematic review. Pain Med. 2016;17(4):658-669.
- Systematic review on the outcomes and safety profile of cervical medial branch radiofrequency. It reinforces that the procedure is both safe and effective when performed under imaging guidance by trained specialists.
https://pubmed.ncbi.nlm.nih.gov/26359589/
10. Patel N, Gross A, Brown L, Gekht G. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. 2012;13(3):383-398.
- Included for context on radiofrequency in other spinal joints, highlighting broader relevance. This study shows that radiofrequency principles extend beyond the facet joints and can be effective for other causes of chronic back pain.
https://pubmed.ncbi.nlm.nih.gov/22299761/
11. McCormick ZL, Conger A, Kendall R, et al. A pragmatic randomized prospective trial of cooled radiofrequency ablation vs facet joint injection for lumbar facet syndrome. Pain Med. 2023;24(12):1318-1331.
- This trial compared cooled radiofrequency ablation with steroid facet joint injections in patients pre-selected by dual medial branch blocks. It found significantly higher pain relief and function improvement in the radiofrequency group at 3, 6, and 12 months.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10690866/
12. Park S, Park JH, Sokpeou N, Jang JN, Kim YU, Choi YS, Park S. Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis. Reg Anesth Pain Med. 2024 Oct 31:rapm-2024-105883.
- Network meta-analysis reviewing 25 randomized trials comparing radiofrequency, sham, facet injections, and conservative care for lumbar facet joint syndrome. It ranked endoscopic and thermal radiofrequency highest for sustained pain and function improvement.
