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A facet joint injection is a precision, image-guided injection placed into or around one of the small joints that connect the vertebrae. The procedure serves two purposes in one visit: it confirms whether a specific facet joint is the source of chronic back or neck pain, and the corticosteroid component can provide weeks to months of therapeutic relief.
Facet joint injections are for adults in Houston with chronic back or neck pain that has not improved with rest, physical therapy, or oral medications, especially when the pain is deep and aching, localized rather than radiating, and worse with twisting, bending backward, or prolonged standing. They are also used as the first diagnostic step before medial branch blocks and radiofrequency ablation.
or call 346-217-1111 · Houston office
By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated May 2026
On This Page:
- What Is a Facet Joint Injection?
- What Are Facet Joints and Why Do They Cause Pain?
- Conditions Treated with Facet Joint Injections
- How the Procedure Works
- What to Expect Before, During, and After
- Benefits of Facet Joint Injections
- Risks and Side Effects
- The Diagnostic-to-Treatment Pathway
- Cost and Insurance
- Facet Joint Injections at Our Houston Office
- Frequently Asked Questions
Houston sits at the heart of the Texas Medical Center ecosystem, with a patient population that includes oilfield and offshore workers, longshoremen and Ship Channel logistics staff, NASA engineers from the Clear Lake corridor, healthcare professionals across TMC, and active-adult residents from the Galleria, River Oaks, West University, Sugar Land, The Woodlands, and Katy. The unifying thread is years of high-load work or active living, often interrupted by chronic back or neck pain that no longer responds to rest, physical therapy, or oral medications. Chronic back pain and neck pain affect millions of Americans, with research estimating a lifetime prevalence as high as 65 to 80 percent in U.S. adults (Urits et al., Curr Pain Headache Rep, 2019). When the source is the small joints along the spine (the facet joints), a facet joint injection can identify the source and, in many cases, provide weeks to months of relief.
At Performance Pain and Sports Medicine in Houston, Dr. Suzanne Manzi, MD and Dr. Matthias Wiederholz, MD perform facet joint injections using fluoroscopic (real-time X-ray) guidance for precise needle placement. Conservative, non-surgical spine treatments are always explored first. Our Houston office is located in the T-Mobile Tower on the Southwest Freeway, near the intersection of I-59 and the 610 West Loop.
What Is a Facet Joint Injection?
A facet joint injection is an injection of local anesthetic, and in some cases a corticosteroid, into or around one of the small joints that connect the vertebrae of the spine. The procedure is performed under fluoroscopic guidance, which allows the physician to visualize needle placement in real time and confirm accurate positioning with contrast dye.
Facet joint injections serve two distinct clinical purposes. As a diagnostic tool, the injection helps determine whether a specific facet joint is the source of a patient’s pain. If the anesthetic provides significant short-term relief, the physician can confirm that the treated joint is contributing to the pain. If it does not, other structures can be investigated. This diagnostic role is one of the most valuable aspects of the procedure, because imaging alone cannot always identify which joint is generating pain.
As a therapeutic treatment, the corticosteroid component can reduce inflammation within the joint, providing relief that may last weeks to several months depending on the severity of the condition and the individual patient’s response. A 2025 systematic review found that corticosteroid facet joint injections provide significant improvement in both pain relief and functional capacity for patients with chronic axial spinal pain (Kaye et al., Curr Pain Headache Rep, 2025).
A facet joint injection is not the same as an epidural steroid injection. An epidural injection delivers medication into the epidural space surrounding the spinal cord and nerve roots, typically to address radiating leg or arm pain. A facet joint injection targets the joint itself, addressing localized axial pain in the back or neck. The two procedures treat different pain generators and are selected based on the patient’s specific diagnosis.
What Are Facet Joints and Why Do They Cause Pain?
Facet joints are small, paired joints located along the back of the spine at every vertebral level. Each vertebra connects to the one above and below it through these joints, which allow the spine to bend, twist, and extend while maintaining stability. Like larger joints such as the knee or shoulder, facet joints are lined with cartilage, surrounded by a capsule, and vulnerable to arthritis and injury.
Facet joints exist throughout the spine:
- Cervical facet joints (neck) allow the head and neck to rotate and tilt
- Thoracic facet joints (mid-back) provide stability in the ribcage region
- Lumbar facet joints (lower back) bear significant weight and are the most commonly affected
When facet joints become irritated or inflamed, the resulting pain is typically felt as a deep, aching discomfort in the back or neck that worsens with certain movements. Twisting, bending backward, or standing for prolonged periods often aggravates facet joint pain. Unlike nerve compression pain (such as sciatica), facet joint pain tends to stay localized rather than radiating far down the arms or legs.
The ASIPP 2020 guidelines report that facet joints are responsible for an estimated 27 to 40 percent of chronic low back pain cases and a significant percentage of chronic neck pain (Manchikanti et al., Pain Physician, 2020). Degenerative disc disease, osteoarthritis, repetitive stress, and spinal injuries can all contribute to facet joint deterioration over time (Allegri et al., F1000Research, 2016).
Conditions Treated with Facet Joint Injections
Facet joint injections are most appropriate for patients whose pain originates from the facet joints rather than from nerve compression, disc herniation, or muscular strain. The following conditions commonly respond to facet joint injection therapy.
- Facet joint arthritis (facet arthropathy) is the most frequent indication. As spinal joints wear down over time, cartilage thins and inflammation develops within the joint capsule. This may occur as a standalone condition or alongside degenerative changes elsewhere in the spine.
- Degenerative disc disease can contribute to facet joint pain indirectly. As intervertebral discs lose height and cushioning, the facet joints at the back of the spine absorb more load than they were designed to carry. This increased stress can accelerate joint inflammation and breakdown. This pattern is common in patients with years of heavy lifting on the Ship Channel, offshore platforms, or in petrochemical plant turnarounds, as well as in long-tenured TMC nurses and surgeons.
- Cervical facet joint pain produces neck pain, stiffness, and in some cases headaches that originate from the upper cervical joints (cervicogenic headaches). Research supports the use of cervical facet joint injections as an effective treatment for cervical facet joint syndrome, with image-guided techniques achieving accuracy rates between 92 and 98 percent (Viva et al., J Clin Med, 2024). Cervical facet pain is frequently seen in Houston knowledge workers from the Energy Corridor, the Galleria, Greenway Plaza, and Memorial whose workdays involve sustained seated and screen-facing posture.
- Lumbar facet joint pain typically presents as a deep ache in the lower back that may refer into the buttocks or upper thighs. Pain often worsens when bending backward, twisting, or standing for extended periods. The L4-L5 and L5-S1 levels are among the most commonly affected.
Patients who experience primarily axial back pain or neck pain rather than radiating nerve pain down the arms or legs are generally the best candidates for facet joint injections.
How the Facet Joint Injection Procedure Works
Facet joint injections are performed as outpatient procedures, typically in a procedure room equipped with fluoroscopy. The entire process usually takes 15 to 30 minutes.
Before the injection, the patient lies face down on a procedure table. The physician identifies the target facet joint using fluoroscopic imaging and cleans the skin over the injection site. A local anesthetic numbs the skin and underlying tissue.
During the injection, the physician advances a thin needle toward the facet joint under continuous fluoroscopic guidance. Once the needle is positioned at the joint, a small amount of contrast dye is injected to confirm accurate placement. The physician then injects the treatment medication, which typically includes a local anesthetic such as lidocaine or bupivacaine. A corticosteroid may also be included depending on whether the injection is primarily diagnostic or therapeutic.
After the injection, the patient rests briefly in a recovery area. Most patients are monitored for 15 to 30 minutes before being cleared to leave. The needle puncture site requires only a small adhesive bandage.
Multiple facet joints can be treated during a single session if the physician determines that more than one joint may be contributing to the patient’s pain. Both sides of the spine can be addressed if needed.
The use of fluoroscopic guidance throughout the procedure is not optional. The ASIPP 2020 guidelines establish Level I evidence with strong recommendation for mandatory fluoroscopic or CT guidance for all facet joint interventions (Manchikanti et al., Pain Physician, 2020).
What to Expect Before, During, and After
- Preparing for your appointment. Most patients do not need to fast before a facet joint injection. The physician may ask you to temporarily stop blood-thinning medications for a few days prior to the procedure, depending on your medical history. Bring a list of current medications and any recent imaging (X-ray or MRI) to your appointment.
- During the procedure. You will feel a brief sting when the local anesthetic numbs the skin. After that, most patients describe a sensation of pressure rather than sharp pain as the needle is guided into position. The injection itself takes only a few minutes. You remain awake and alert throughout the procedure unless sedation is specifically requested.
- After the procedure. You can expect to rest in the office for a brief monitoring period before going home. Most patients are able to drive themselves. Light activity around the house is encouraged on the day of the procedure. Avoid heavy lifting, intense exercise, and prolonged bending for 48 hours. Small adhesive bandages can be removed the following day, and showering is typically fine within 24 hours.
- When to expect results. The local anesthetic may provide immediate but temporary pain relief that wears off within several hours. If a corticosteroid was included, the anti-inflammatory effect typically develops over the following 3 to 7 days. Pain relief from the steroid component may last several weeks to a few months. If relief is short-lived but significant, this finding is still clinically valuable because it confirms the facet joint as the pain source and guides next steps in your treatment plan.
Benefits of Facet Joint Injections
Facet joint injections offer several advantages over other pain management approaches for patients with confirmed or suspected facet joint pain.
- Minimally invasive. The procedure uses a thin needle with no surgical incision, no stitches, and no scar tissue formation.
- Diagnostic clarity. A facet joint injection can confirm whether the facet joint is the source of your pain. This diagnostic value is unique among pain treatments and directly informs the next steps in your care.
- Targeted pain relief. Medication is delivered directly to the affected joint rather than distributed throughout the body, reducing systemic side effects associated with oral pain medications.
- Same-day, outpatient procedure. The injection takes 15 to 30 minutes, and most patients return to normal activities within one to two days.
- May reduce reliance on oral medications. For patients managing chronic pain with daily medications, successful facet joint injections can reduce the need for systemic pain relief.
- Guides the treatment pathway. The response to a facet joint injection helps the physician determine whether to proceed with a medial branch block and, if confirmed, radiofrequency ablation for longer-lasting relief.
Individual results vary based on the severity of joint degeneration, the accuracy of diagnosis, and overall health.
Risks and Side Effects
Facet joint injections are considered low-risk procedures, but like any medical intervention, they carry potential side effects. Understanding these risks is part of making an informed decision about your care.
- Common side effects:
- Temporary soreness or tenderness at the injection site, typically lasting one to two days
- Minor bruising or swelling at the needle entry point
- Brief increase in pain before the medication takes effect
- Steroid-specific side effects (when corticosteroid is included):
- Temporary insomnia or feeling jittery for a day or two
- Facial flushing or redness
- Temporary elevation in blood sugar levels, which patients with diabetes should monitor closely
- Rare complications:
- Infection at the injection site (risk is very low due to sterile technique)
- Allergic reaction to the injected medication
- Nerve injury (extremely rare, as the needle does not enter the epidural space)
Because facet joint injections are needle-based procedures, there is no surgical incision, no general anesthesia in most cases, and no prolonged recovery period. The overall complication profile is favorable compared to more invasive spinal interventions.
Your physician will review your complete medical history, current medications, and any allergies before scheduling the procedure. Patients on blood-thinning medications will receive specific instructions about temporary medication adjustments.
The Diagnostic-to-Treatment Pathway
One of the most important aspects of facet joint injections is their role in a structured, evidence-based treatment pathway. Rather than a standalone procedure, a facet joint injection is often the first step in a sequence that leads to progressively longer-lasting pain relief.
- Step 1: Facet joint injection (diagnostic and therapeutic). If the injection provides significant pain relief, even temporarily, this confirms that the facet joint is the source of your pain. Relief that lasts several weeks to months may be sufficient on its own. If the pain returns, the next step in the pathway is considered.
- Step 2: Medial branch block (confirmatory diagnostic). A medial branch block targets the small nerves that carry pain signals from the facet joint to the brain. If this second injection also provides meaningful relief, it confirms the diagnosis with a higher degree of confidence and qualifies the patient for a longer-lasting treatment.
- Step 3: Radiofrequency ablation (long-term treatment). Radiofrequency ablation uses targeted heat energy to reduce pain signaling from the confirmed facet joint nerves. A systematic review found that radiofrequency ablation is more effective than placebo for both pain control and functional improvement in patients with facet joint pain (Poetscher et al., Spine, 2014). Pain relief from radiofrequency ablation may last six months to a year or longer, and the procedure can be repeated if needed.
This staged approach protects patients from unnecessary procedures. Each step provides additional diagnostic confirmation before advancing to the next level of intervention. The ASIPP 2020 guidelines support this pathway with Level II evidence for both therapeutic facet joint nerve blocks and radiofrequency ablation in the lumbar spine (Manchikanti et al., Pain Physician, 2020).
Cost and Insurance
Facet joint injections are typically covered by most major insurance plans when deemed medically necessary. Coverage may require prior authorization from the insurance company before the procedure is performed. The cost is generally comparable to other image-guided spinal injections such as epidural steroid injections.
Our Houston office accepts most major commercial insurance plans, Medicare, and Texas workers’ compensation, and routinely handles documentation for injuries sustained on Ship Channel terminals, in petrochemical plant turnarounds, on offshore platforms, and in Houston healthcare settings. The office team can verify your specific insurance coverage and discuss any out-of-pocket costs before your appointment. For coverage questions, call 346-217-1111.
Facet Joint Injections at Our Houston Office
Performance Pain and Sports Medicine performs facet joint injections at the Houston office at 4126 Southwest Freeway, Suite 1700, Houston, TX 77027, in the T-Mobile Tower on the Southwest Freeway. The location sits inside the 610 Loop near the intersection of I-59 and 610 West, with covered garage parking and validation, making it convenient for patients from Uptown, the Galleria, River Oaks, West University, Bellaire, Memorial, the Energy Corridor, the Texas Medical Center, Greenway Plaza, Sugar Land, Missouri City, Pearland, Katy, and The Woodlands.
Dr. Suzanne Manzi, MD is board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. Her fellowship training in interventional spine and pain management, combined with her role as teaching faculty at UT Health Houston McGovern Medical School, provides both clinical depth and an evidence-based approach to facet joint diagnosis and treatment. Dr. Manzi also brings specialized expertise in electrodiagnostic testing (EMG/NCS), which supports precise identification of pain generators before any injection is recommended.
Dr. Matthias Wiederholz, MD is board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Sports Medicine, and Anti-Aging, Regenerative and Functional Medicine. He founded Performance Pain and Sports Medicine in 2009 and continues to perform interventional spine procedures alongside Dr. Manzi at the Houston office. Jade Nemeth, PA-C supports patients throughout evaluation, treatment, and follow-up care.
The Houston patient population reflects the city’s unique mix of high-load industrial work, world-class medical and research employment, and active suburban living. Oilfield workers, offshore crews, longshoremen, Ship Channel logistics staff, NASA engineers from the Clear Lake corridor, TMC healthcare professionals, Galleria-area knowledge workers, and active-adult residents from Memorial, Sugar Land, The Woodlands, and Katy all present with chronic axial back and neck pain that has not responded to standard care. The office accepts most major commercial insurance, Medicare, and Texas workers’ compensation, and routinely handles referrals from Texas Medical Center providers, Houston Methodist, Memorial Hermann, HCA Houston, and primary care offices across Greater Houston.
What sets the Houston practice apart:
- Fellowship-trained interventional pain specialists performing every procedure
- Fluoroscopic guidance for all facet joint injections
- Comprehensive diagnostic evaluation before recommending any intervention
- A complete treatment pathway from injections through radiofrequency ablation, all under one roof
- Most major insurance plans accepted
To schedule an evaluation, call the Houston office at 346-217-1111 or contact us online. Facet joint injections are also available at the League City, Baytown, and Lawrenceville Performance Pain locations.
Performance Pain and Sports Medicine
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, Suite 1700
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Phone: 346-217-1111
Frequently Asked Questions
Is the facet joint injection procedure available at the Houston office?
Yes. Facet joint injections for the cervical, thoracic, and lumbar spine are performed at the Houston office in the T-Mobile Tower on the Southwest Freeway, by Dr. Suzanne Manzi, MD and Dr. Matthias Wiederholz, MD. All procedures use live fluoroscopic guidance and are completed as outpatient visits, with most patients leaving the office within 30 to 45 minutes of the injection.
Do you accept workers' compensation for oilfield, offshore, Ship Channel, or TMC healthcare injuries?
Yes. The Houston office accepts Texas workers’ compensation and routinely treats injured workers from oil and gas companies, offshore operators, longshore and Ship Channel terminal employers, petrochemical contractors, and Texas Medical Center healthcare systems. The office handles documentation and authorization directly with carriers.
How long does a facet joint injection last?
Pain relief varies depending on whether the injection is primarily diagnostic or therapeutic. The local anesthetic component wears off within several hours. If a corticosteroid is included, the anti-inflammatory effect typically develops over 3 to 7 days and may provide relief lasting several weeks to a few months. When relief is significant but short-lived, this is still a valuable outcome because it confirms the facet joint as the pain source and qualifies the patient for longer-lasting treatments such as radiofrequency ablation.
Are facet joint injections painful?
The physician numbs the skin and tissue over the injection site with a local anesthetic before the procedure begins. Most patients describe a brief sting from the initial numbing injection followed by a sensation of pressure as the needle is guided into position. The experience is comparable to other spinal injections such as an epidural steroid injection. Sedation is available for patients who experience significant anxiety about needle-based procedures, though most patients do not require it.
Are facet injections the same as steroid injections?
No. “Steroid injection” is a general term for any injection containing a corticosteroid. “Facet joint injection” refers to the specific location where the medication is delivered. A facet joint injection may or may not contain a steroid. When used for diagnostic purposes, the injection typically contains only a local anesthetic. When used therapeutically, a corticosteroid is often added to reduce inflammation within the joint.
How much do facet joint injections cost?
Facet joint injections are typically covered by most major insurance plans when deemed medically necessary. Coverage may require prior authorization from the insurance company before the procedure is performed. The cost is generally comparable to other image-guided spinal injections such as epidural steroid injections. The Houston office staff can verify your specific insurance coverage and discuss any out-of-pocket costs before your appointment.
Can I drive after a facet joint injection?
Most patients can drive themselves home after the procedure. Facet joint injections are typically performed without sedation, so patients are fully alert when the procedure is complete. If sedation is used, you will need someone to drive you home. Your physician will confirm whether driving is appropriate based on your specific situation.
What is the difference between a facet joint injection and a medial branch block?
A facet joint injection delivers medication directly into or immediately around the facet joint itself. A medial branch block targets the small medial branch nerves that carry pain signals from the facet joint to the brain. Both procedures can serve diagnostic and therapeutic purposes, but they target different anatomical structures. In many treatment plans, a facet joint injection is performed first, followed by a medial branch block to confirm the diagnosis before proceeding to radiofrequency ablation.
What is the next step if a facet joint injection does not provide lasting relief?
If a facet joint injection provides significant but temporary relief, the typical next step is a medial branch block to confirm the diagnosis. If the medial branch block also provides relief, the patient may be a candidate for radiofrequency ablation, which can provide pain relief lasting six months to a year or longer. If a facet joint injection does not provide any relief, the physician will investigate other potential pain generators such as disc pathology, sacroiliac joint dysfunction, or nerve compression. A thorough diagnostic evaluation ensures that treatment targets the correct structure.
Do you accept referrals from Houston Methodist, Memorial Hermann, HCA Houston, and TMC providers?
Yes. The Houston office accepts referrals from Texas Medical Center providers, Houston Methodist, Memorial Hermann, HCA Houston, and primary care offices across Greater Houston. Self-referral is also accepted for most insurance plans.
Schedule Your Facet Joint Injection Consultation in Houston
For patients in Greater Houston living with chronic back or neck pain that has not responded to rest, physical therapy, or oral medications, a facet joint injection may help identify the source of the pain and provide targeted relief. Contact Performance Pain and Sports Medicine or call 346-217-1111 to schedule a consultation with Dr. Suzanne Manzi, MD or Dr. Matthias Wiederholz, MD.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Medically reviewed by Dr. Suzanne Manzi, MD · Performance Pain and Sports Medicine · Last reviewed: May 2026
Medically reviewed by Suzanne Manzi, MD
Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine
Last reviewed: May 2026
