When dealing with chronic facet joint pain, facet joint injections are often one of the first treatment options. At Performance Pain and Sports Medicine, board-certified pain specialists Dr. Matthias Wiederholz and Dr. Suzanne Manzi administer these injections to reduce inflammation in the joints, aiming for targeted relief. However, while effective for many, facet joint injections don’t always provide lasting results for every patient. If you’re wondering what to do if facet joint injections don’t work, this guide outlines the next steps.
When injections fall short, patients have a range of alternative treatments that can offer substantial pain relief and improved function. Below, Dr. Wiederholz and Dr. Manzi share their expertise to walk you through the options—from additional minimally invasive procedures to non-invasive therapies and lifestyle adjustments. By following their expert guidance, you’ll have the information and support you need to explore a full spectrum of personalized pain management solutions.
For a facet joint injection to be effective, it must reach the precise location where inflammation is causing pain. However, certain anatomical factors can complicate this. Dense bones, unique anatomical structures, or even inflammation itself can sometimes prevent the injection from being placed accurately. These anatomical barriers may mean that the medication doesn't reach the target site, limiting its effectiveness. Patients with complex bone structures or severe inflammation might find that injections provide only partial or temporary relief.
Facet joint pain is commonly misdiagnosed due to overlapping symptoms with other spinal issues like spinal stenosis or herniated discs. When the primary pain source is another condition, like a compressed nerve or a misaligned disc, targeting only the facet joints won’t address the true cause of pain. For patients who don’t experience relief from facet joint injections, it's essential to revisit the diagnosis with a healthcare provider to ensure that the underlying cause has been accurately identified.
Even when facet joint injections are applied correctly and the diagnosis is accurate, some patients may simply not respond as expected. Factors such as genetics, general health, and pain tolerance levels can all influence how someone reacts to injections. What works for one person might not work for another, making it important to remain open to alternative approaches if injections aren’t effective.
Medial branch radiofrequency neurotomy, or RFA, is a minimally invasive procedure that targets the nerves transmitting pain signals from the facet joints. Using radiofrequency energy, the procedure "burns" or ablates these nerves, reducing their ability to send pain signals. This option can provide relief that lasts from six months to two years, depending on the patient’s response and nerve regeneration. RFA is often ideal for individuals who experienced temporary relief from injections but seek a more lasting solution.
Spinal cord stimulation (SCS) is a unique approach to managing chronic pain. It involves placing a small device near the spinal cord to deliver electrical pulses that disrupt pain signals before they reach the brain. SCS differs from facet joint injections by providing continuous modulation of pain signals, which can be effective for patients with persistent, unmanageable pain. This treatment is typically considered when other interventions have failed, and it is particularly useful for nerve-related pain that doesn’t respond to standard injections.
In many cases, what appears to be pain originating from the facet joints may actually be caused by a leaky disc. When the outer layer of an intervertebral disc is damaged, its inner material can seep out and irritate surrounding areas, including the facet joints, resulting in inflammation and pain. This irritation can mimic the symptoms of facet joint pain, even though the true source is a damaged or “leaky” disc.
For patients experiencing this type of pain, the Discseel® Procedure offers a minimally invasive solution by targeting the damaged disc directly. This procedure involves injecting a specialized biologic sealant into the affected disc, which works to close off the tears, stopping the leakage and promoting natural healing. By addressing the root cause of the inflammation, the Discseel® Procedure can effectively reduce or eliminate pain that was initially mistaken as being solely facet joint-related.
The Discseel® Procedure will be discussed in more detail later in this article, but it serves as an important option for those whose facet joint pain may actually stem from underlying disc issues. This advanced technique can provide lasting relief by focusing on true sources of spinal pain rather than solely on surface symptoms.
Physical therapy is one of the most effective non-invasive options for managing facet joint pain. A physical therapist can design a program to strengthen muscles around the spine, increase flexibility, and improve posture, all of which reduce strain on the facet joints. Specific exercises, such as core stabilization and stretching routines, can provide substantial, lasting relief by supporting spinal alignment and stability. For many patients, physical therapy becomes a cornerstone of their long-term pain management strategy.
Chiropractic adjustments can also be helpful for facet joint pain by aligning the spine, reducing pressure on the joints, and promoting natural healing. A chiropractor trained in spinal adjustments can improve range of motion and alleviate pain by addressing misalignments that contribute to joint stress. Adjustments are generally safe when performed by a qualified professional and can complement other treatments by addressing the root causes of facet joint irritation.
Certain lifestyle adjustments can make a big difference in managing facet joint pain. Regular, low-impact exercise, such as walking or swimming, helps maintain spinal health without putting undue strain on the joints. Incorporating anti-inflammatory foods into your diet, such as omega-3-rich fish, leafy greens, and berries, can also support the body’s healing process. Additionally, ergonomics play a crucial role; consider improving posture and investing in supportive furniture to minimize strain on the spine throughout the day.
Epidural steroid injections can provide relief similar to facet joint injections but with a broader focus. Instead of targeting the facet joints specifically, epidurals deliver anti-inflammatory medication into the epidural space around the spine, reducing inflammation in the surrounding nerve roots. This can be particularly beneficial for patients who have nerve-related pain in addition to joint pain, such as sciatica or radiculopathy.
BOTOX injections, while commonly associated with cosmetic treatments, have applications in pain management as well. For patients whose pain is compounded by muscle spasms, BOTOX can help relax these muscles, reducing overall tension and discomfort. Although BOTOX is typically not a primary treatment for facet joint pain, it can be effective in conjunction with other therapies when muscular tension plays a significant role in the pain experience.
Spinal blocks offer another injection option, targeting larger areas of the spine compared to facet joint injections. These blocks can temporarily numb nerve activity, providing short-term relief that may help patients manage severe pain episodes or assess their response to numbing therapies before considering longer-lasting interventions.
For patients whose pain persists despite other interventions, surgery may be an option. Procedures like facet rhizotomy and spinal fusion can offer long-term relief by either disabling painful nerves or stabilizing the affected area of the spine. Facet rhizotomy uses radiofrequency energy to target specific nerves, while spinal fusion creates a stable connection between two vertebrae. These surgeries are generally recommended for patients who have exhausted less invasive options and are experiencing a significant reduction in quality of life.
Surgery for facet joint pain comes with risks, including infection, nerve damage, and prolonged recovery times. The recovery period varies depending on the specific procedure, but it’s crucial for patients to understand what to expect and to work closely with their healthcare provider during this time. While some patients find dramatic relief, others may experience only partial improvements, so weighing the potential outcomes is essential.
Deciding between surgical and non-surgical treatments is a deeply personal decision that should be made in consultation with a specialist. It’s important to evaluate the extent of your pain, your overall health, and how much the pain impacts your daily activities. Many patients find that a careful balance of conservative treatments can maintain their quality of life without needing surgery, but for some, surgery becomes a necessary step toward lasting relief.
For patients seeking a minimally invasive solution for herniated discs, The Discseel® Procedure offers a groundbreaking approach designed to repair damaged spinal discs without the need for traditional surgery. This advanced procedure involves injecting a specialized biologic into the affected disc, promoting natural healing and stabilization by sealing any tears or fissures. Unlike conventional treatments that may only address symptoms, Discseel aims to restore the disc’s integrity and provide long-term relief.
At Performance Pain and Sports Medicine, Dr. Matthias Wiederholz, a board-certified pain management specialist, is uniquely qualified to perform the Discseel Procedure. Trained directly by Dr. Pauza, the procedure’s founder, Dr. Wiederholz is the first physician in Houston to receive this specialized training, making our clinic a pioneer in offering this advanced treatment. Dr. Wiederholz is available for Discseel consultations at our Houston, Texas, and Lawrenceville, New Jersey locations, allowing patients access to one of the most innovative treatments available for disc-related pain.
By choosing the Discseel Procedure, patients benefit from a minimally invasive approach that targets the root cause of herniated disc symptoms, offering a pathway to improved function and quality of life without the extended recovery time associated with traditional spinal surgery.
How to Decide the Best Path Forward When choosing a treatment path, it’s important to consider your unique symptoms and lifestyle needs. If your pain is localized and episodic, conservative options like physical therapy or chiropractic care might be sufficient. For more widespread or intense pain, interventional treatments like RFA or spinal cord stimulation could provide the relief you need.
A multi-specialist approach can ensure that all aspects of your pain are addressed. Consulting with a pain management specialist, an orthopedic surgeon, or a physical therapist can help you explore different perspectives and find a comprehensive treatment plan that suits your specific needs.
Setting realistic goals and managing expectations are essential parts of the pain management journey. Working with your healthcare provider to establish achievable milestones, regularly monitoring your progress, and adjusting treatments as needed can improve your chances of finding effective relief and maintaining an active lifestyle.
If facet joint injections haven’t provided the relief you need, remember that there are still many effective paths forward. From advanced injection options and physical therapy to minimally invasive surgeries, there is hope for managing facet joint pain.
Dr. Wiederholz, Dr. Manzi, and the team at Performance Pain and Sports Medicine are dedicated to helping each patient build a personalized, multifaceted approach to achieve lasting relief and regain quality of life. Dr. Wiederholz is available for consultations at our Houston, TX, and Lawrenceville, NJ, locations, offering expert guidance to explore tailored solutions for your unique needs. Reach out today to schedule a consultation and take the next step toward optimal pain management and well-being.
