Facet joint injections vs nerve blocks
If you've been reading about spinal pain procedures, you've probably come across both "facet joint injections" and "nerve blocks." They sound similar, and there's some overlap — but they're used for different reasons. Here's a plain-language explanation.
First, what they have in common
Both are image-guided procedures, meaning they use real-time imaging — often fluoroscopy (live X-ray) — to place a needle precisely at a specific target in or near the spine. Both are usually done under local anaesthetic, as day procedures, and both aim to reduce pain from a specific source. The difference is what they target and why.
Facet joint injections
The facet joints are the small joints at the back of the spine that allow it to bend and twist. Like any joint, they can become a source of pain — often felt as a deep, aching pain in the back or neck that can worsen with certain movements.
A facet joint injection delivers medication in or around one of these joints. It's typically used when the facet joints are thought to be the source of pain, both to provide relief and, in some cases, to help confirm whether that joint is really the problem.
Nerve blocks (medial branch blocks)
A nerve block targets a nerve rather than a joint. In the context of facet-related pain, the relevant procedure is often a medial branch block — the medial branches are the small nerves that carry pain signals from the facet joints.
By temporarily numbing these specific nerves, a medial branch block helps work out whether those nerves — and therefore those joints — are the true source of your pain. If a block gives good but temporary relief, it can point toward a longer-lasting treatment aimed at the same nerves.
Nerve blocks are also used in other parts of the spine for different targets — for example, near a nerve root in cases of sciatica-type pain — so "nerve block" is really a family of procedures rather than a single one.
So how does a doctor choose?
The choice isn't about which procedure is "better" — it's about matching the procedure to the likely source of your pain and the goal of the treatment. Sometimes the aim is mainly relief; sometimes it's partly diagnostic, helping to confirm where the pain is coming from so that the next step can be more targeted.
This is why individual assessment matters so much. The pattern of your pain, your examination and any imaging all feed into deciding which procedure — if any — is likely to help. Two people with "back pain" can need very different approaches.
The bottom line
Facet joint injections target a joint; medial branch blocks target the nerves that supply that joint; and other nerve blocks target different nerves for different problems. They're related tools with distinct jobs. Which one suits you — and whether a procedure is the right choice at all — is something to work out through a proper assessment.
Related: Learn more about Image-guided procedures, or request an appointment.
This article is general information, not medical advice, and doesn't replace an individual assessment. If you have concerning symptoms, please see a doctor.