Facet-mediated pain. Precisely diagnosed and treated.
The facet joints of the spine are small paired joints between the vertebral bodies that allow the spine to move. When these joints become arthritic or inflamed, they can produce a specific pain pattern — often localized back or neck pain that worsens with extension and rotation — that is frequently mistaken for disc-related pain and treated ineffectively.
Facet joint injections and medial branch blocks are the diagnostic and therapeutic procedures for facet-mediated pain. A medial branch block uses local anesthetic to temporarily numb the small nerve that supplies the facet joint — if this produces significant pain relief, the facet is confirmed as the pain source. A facet joint injection places corticosteroid directly into the joint for longer-lasting relief.
Both procedures at NCSS are performed under ultrasound guidance by Dr. Scott personally, in our AAAHC-accredited operating rooms. No fluoroscopy radiation is used.
Who this procedure is designed for.
Facet injections and medial branch blocks address a specific pain pattern. The consultation determines whether your presentation is a fit.
Axial back or neck pain without radicular component
Pain localized to the spine itself, without significant leg or arm symptoms.
Pain that worsens with extension and rotation
Bending backwards, twisting, or standing for prolonged periods.
Facet arthropathy on imaging
MRI or CT showing arthritic changes at the facet joints, particularly at the levels of maximum pain.
Failure of conservative measures
Physical therapy, NSAIDs, and activity modification have provided insufficient relief.
Chronic mechanical back pain of unclear origin
Medial branch block can be diagnostic — determining whether facet involvement is a significant contributor.
Post-whiplash cervical pain
Cervical facet joints are commonly injured in whiplash-mechanism trauma.
Every pain-management patient at NCSS is seen personally by Dr. Rand Scott for the consultation — not delegated to a mid-level provider.
Three stages, one procedure.
Facet procedures are same-day, performed in one of our operating rooms with sedation available if needed. The approach differs slightly between diagnostic (medial branch block) and therapeutic (facet injection):
Diagnostic medial branch block
Local anesthetic is deposited near the small medial branch nerve that supplies the facet joint. If this produces significant pain relief (typically >50%), the facet is confirmed as the pain source.
Therapeutic facet joint injection
Corticosteroid combined with local anesthetic is injected directly into the facet joint for longer-lasting anti-inflammatory effect.
Ultrasound guidance throughout
Real-time visualization of the target facet or medial branch — no X-ray radiation to you or the physician.
Multiple levels commonly treated in one session
Facet arthropathy often affects several adjacent levels; these can be treated together.
Bilateral treatment
Facets on both sides of the spine at a given level are commonly treated in the same session.
Each injection typically takes only a few minutes; total procedure time depends on the number of levels being treated. Facility time is typically 60–90 minutes.
Two sites. One recovery.
Discharged after brief post-procedure observation. If sedation was used, someone must drive you home.
The local anesthetic component provides immediate but temporary relief — this helps confirm the facet as the pain source. Injection-site soreness is common; ice helps.
The steroid component gradually takes effect. For diagnostic medial branch blocks, the immediate response is what informs the diagnosis.
Duration of therapeutic benefit varies. Some patients get months of relief; others need repeat injection at intervals.
Most patients can return to normal activity the following day. Physical therapy continuation is often recommended alongside the injections.
If facet injections provide meaningful but time-limited relief, options for longer-duration approaches are discussed — noting that radiofrequency ablation is not offered at NCSS, per current pain literature.
Follow-up with Dr. Scott occurs at Newport Pain Management for ongoing pain management coordination.
The medical director. Personally.
All interventional pain procedures at NCSS are performed by Dr. Rand Scott himself.
H. Rand Scott, MD
BOARD-CERTIFIED ANESTHESIOLOGIST · PAIN MANAGEMENT SUBSPECIALTYFounder of Newport Pain Management (1996) and Medical Director of NCSS. Ultrasound-guided technique, no fluoroscopy radiation.
Meet the medical director →The right starting point is a conversation.
Every facet injection consultation at NCSS begins with Dr. Scott personally — a careful review of your imaging, your pain pattern, and whether this procedure is the right fit.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Epidural Steroid Injections
For radicular pain (arm or leg symptoms following a nerve-root distribution) rather than facet-mediated axial pain.
Learn more →Sacroiliac Joint Injections
Another source of low back pain that can be difficult to distinguish clinically from facet-mediated pain.
Learn more →Newport Pain Management
Dr. Scott's comprehensive pain practice adjacent to NCSS — for the broader diagnostic and treatment relationship.
Visit newportpain.com →