The origin of facetogenic pain can be confirmed with diagnostic medial branch blocks which are small injection with local anaesthetic to nerves supplying facet joints. This usually requires 3 injections at one side of the spine done under X-Ray in the theatre complex. This injection has only diagnostic purpose (to get more information) and effect will last about one day. Based on the outcome of injection radiofrequency ablation procedure may be indicated.
Radiofrequency ablation (RF) to medial branches -a procedure which ablates ('burns') small nerve endings which transmit pain from facet joints. Procedure is recommended by The National Institute for Health and Care Excellence (NICE) and all major pain medicine societies. The outcome of the procedure should last many months.
Facet joint injections with steroids – usually up to six injections to facet joints with long acting steroids used to improve lower back pain. Procedure can be very useful for selected patients.
Sacroiliac joint pain can be treated with :
Steroid injections to the joint space – single injection under X-ray which provides a few months pain relief.
Radiofrequency ablation (RF) to nerves supplying sacroiliac joints – similarly to the facetogenic pain this will require first diagnostic injections (usually 3 injections per site) to confirm which nerves transmit pain from the sacroiliac joint. The positive outcome from diagnostic joints predicts high chances of good outcome after radiofrequency ablation. RF is done using multiple needles to provide the best outcome lasting many months.
Pain caused by soft tissues such as muscle. Physiotherapy is usually first line of treatment which can be supported with trigger pain injections with steroid.