Facet joint medial branch blocks
A diagnostic injection of local anaesthetic onto the small medial branch nerves that supply the facet joints of the spine. A positive test confirms that the joints are the source of your pain — and identifies you as a candidate for radiofrequency denervation.
Led by Dr Arul James (Consultant in Pain Medicine, GMC Specialist Register) at The Vesey, Sutton Coldfield. Self-pay and insurance accepted (BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix). Same-week appointments typical.
Who this procedure is for
- Axial (mid-line) back or neck pain that is worse with extension, rotation and prolonged standing.
- Pain that has failed 6–8 weeks of physio, analgesia and an exercise programme.
- Imaging shows facet arthropathy but no nerve-root compression that would explain the pain pattern.
- You are willing to do a two-stage diagnostic test before committing to radiofrequency.
How the procedure is performed
Fluoroscopy-guided injection of 0.5 ml of local anaesthetic onto each medial branch nerve supplying the suspected joint. We typically test two adjacent levels per side. The block itself is rapid; the visit is 45–60 minutes. You record your pain on a structured diary card for the next 8 hours — that diary, not the procedure note, is the diagnostic test.
Before, during and after
- Before: arrive with your usual pain. Do not take strong analgesics in the 4 hours before the test — they confound the result. Bring a diary card (we email it before the appointment).
- During: prone position, local anaesthetic to the skin, two-level test typically takes 15 minutes.
- After: please move, sit, stand and provoke your normal pain pattern. Score your pain hourly for 8 hours. Email the diary back the same day.
Recovery and aftercare
No restrictions on activity — provoking pain is the point. Diagnostic relief is brief (by design) and typically wears off within 4–8 hours. The medial branch block does not itself treat pain long-term; if the test is positive (≥ 70% relief), we proceed to radiofrequency denervation as a second visit.
How many levels are tested at one session? +
Typically two adjacent levels per side at one visit. This covers the most likely pain generators identified on your pre-procedure clinical assessment and imaging.
Do I need to do anything special before the injection? +
Arrive with your usual pain. Do not take strong opioid analgesics in the four hours before the test — they confound the result. Bring your completed pain diary card (emailed to you beforehand).
What happens if the diagnostic block is positive? +
A positive result (≥ 70% relief during the window) confirms the facet joint as the pain source and identifies you as a candidate for radiofrequency denervation, which is then booked as a second procedure.
Can I drive after a medial branch block? +
We advise you do not drive for 4 hours after the procedure, as the local anaesthetic may cause some temporary weakness in back-stabilising muscles. Please arrange a driver or alternative transport.
Pricing at a glance
Initial consultation £260 · Two-level diagnostic medial branch block from £680 (includes consent, image guidance, drugs, recovery and written report). Insurance accepted: BUPA, Vitality, AXA, WPA, Cigna, Aviva, Healix.
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Risks and side effects
Common: brief site soreness, transient numbness or weakness in the back muscles. Uncommon: vasovagal reaction during the procedure. Rare: infection, bleeding, allergic reaction. The diagnostic dose is small and the safety profile is excellent.
When this procedure is not appropriate
Pregnancy, active infection, anticoagulation that cannot be safely paused, or a clear non-facet pain generator (disc, nerve root, sacroiliac joint) that should be tested first.
Cost and pathway
Initial consultation £260. Two-level diagnostic medial branch block from £680 including consent, image guidance, drugs, recovery and written report. If the test is positive, radiofrequency lesioning is booked separately.
- Open 7 days including Sundays — 8am to 8pm, no weekend surcharge
- No GP referral required — book directly with Dr Arul James
- Sutton Coldfield location — serving Birmingham, Walsall, Tamworth, Lichfield and the West Midlands
- CQC-regulated — rated 4.88/5 on Doctify from 700+ verified reviews
View the full pain management pathway →
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands · Open 7 days 8am–8pm
Open 7 days · 8am–8pm · 0121 387 3727