Facet Joint Pain: Medial Branch Block and Radiofrequency Ablation

What are facet joints?

The facet joints are the small paired joints at the back of the spine, where one vertebra meets the next. They guide and limit movement as you bend and twist. Like any joint, they can become irritated with wear, posture or strain. When they do, they can produce localized neck or back pain that is often worse with certain movements - such as leaning back or turning.

The challenge: pinpointing the source

Facet joint pain can feel similar to pain from other structures, and it does not always show clearly on scans. This is why a diagnostic step is often used first - to test whether these joints really are the source before committing to a longer-lasting treatment.

Step 1: Diagnostic medial branch block

The nerves that carry pain signals from the facet joints are called medial branch nerves. In a medial branch block, our pain medicine team uses imaging guidance to place a small amount of local anesthetic near these nerves.

• If your usual pain temporarily eases after the block, it suggests those facet joints are an important source.
• If it does not, that useful information points the search elsewhere.

Because the aim here is to gather information, the effect is often short-lived. It is a test, not the final treatment.

Step 2: Medial branch radiofrequency (RF)

If one or more diagnostic blocks suggest the facet joints are involved, medial branch radiofrequency may be offered. RF uses a fine needle-like probe and controlled heat to calm the medial branch nerves so they carry fewer pain signals from the joint.

The aim is longer-lasting relief than a diagnostic block can give. Nerves can recover over time, so the effect is not permanent, and duration varies between individuals. If pain returns later, the procedure can often be considered again after review.

Facet joint injection: another related option

Sometimes medicine is placed into or around the facet joint itself - a facet joint injection. Depending on your plan, this may use a steroid (to reduce inflammation), PRP (platelet-rich plasma, prepared from your own blood), or prolotherapy (an injection intended to stimulate the body's own repair response). Which one, if any, is suitable is decided by our medical team based on your situation.

How the procedures are done

All of these are image-guided and needle-only:

1. You lie comfortably, usually face down or with your neck supported.

2. The skin is cleaned and numbed.

3. Using fluoroscopy (live X-ray) or ultrasound, the doctor guides the needle to the target.

4. The medicine or RF treatment is delivered.

5. You rest briefly, then in most cases go home the same day.

There are no large incisions. Most patients go home the same day with simple aftercare advice.

What to expect afterward

Experiences vary. Some people notice tenderness at the injection site for a short period. With RF, relief may build over a couple of weeks rather than appearing straight away. Your team will explain what is typical for your specific procedure and arrange follow-up to review your response.

Where this fits in your care

These procedures aim to relieve pain and improve function so you can move and rehabilitate more comfortably. They work best as part of a broader plan that usually includes activity and physical therapy. The diagnostic block, in particular, is about clarity - helping ensure any longer-lasting step is aimed at the right target.

Next step

To find out which option may suit your pain, our medical team can arrange an assessment. Contact us on LINE (@younifyclinic) or WhatsApp +66 81 556 9696.