Guideline Video

Guideline Resources

  • Facet Joint Interventions in the Management of Chronic Spinal Pain
  • American Society of Interventional Pain Physicians
  • June 29, 2026
  • Summary
  • Full-text

Video Transcription

Just published June 29th, 2026, the American Society of Interventional Pain Physicians’ newest guideline on F acet Joint Interventions in the Management of Chronic Spinal Pain.

The purpose of this guideline is to provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions.

In today’s rapid update, we’ll just be going over a summary of evidence and recommendations, so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Non-interventional Diagnosis

  • The level of evidence is moderate in selecting patients for facet joint nerve blocks at least 3 months after onset and failure of conservative management who have axial pain, tenderness over the facet joints, reduced range of motion, exacerbation with extension and lateral rotation, pain reduction with rest, and absence of a radicular pattern, with strong strength of recommendation for physical examination and assessment. 
  • The level of evidence is strong for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs, with strong strength of recommendation. 
  • The level of evidence is strong with strong strength of recommendation for mandatory fluoroscopic or computed tomography (CT) guidance for all facet joint interventions. 
  • The level of evidence is strong supporting the use of single-photon emission computed tomography for identifying painful facet joints before diagnostic facet joint nerve blocks, with weak strength of recommendation.
  • The level of evidence is consensus-based with weak strength of recommendation for scintigraphy, MRI, and CT for identifying painful facet joints. 

Next the section on Interventional Diagnosis

  • The level of evidence is strong to moderate with moderate to strong strength of recommendation for the diagnosis of lumbar facet joint pain by performing lumbar diagnostic facet joint nerve blocks.
  • The level of evidence is moderate with moderate strength of recommendation for the diagnosis of cervical facet joint pain by performing cervical diagnostic facet joint nerve blocks. 
  • The level of evidence is moderate with moderate strength of recommendation for the diagnosis of thoracic facet joint pain by performing thoracic diagnostic facet joint nerve blocks.
  • The level of evidence is moderate that interventional diagnostic approaches should be applied in the chronic phase after 3 months from onset and failure of conservative management modalities, including medical therapy, structured exercise programs, and physical therapy, with noninvasive diagnostic assessment leading to diagnostic facet joint nerve blocks, with strong strength of recommendation. 
  • The level of evidence is strong for the influence of psychological factors affecting the diagnosis, with moderate strength of recommendation to exercise caution in patients with combined depression, anxiety, and somatization disorder. 
  • The level of evidence is moderate that intraoperative opioids may affect the diagnostic validity of facet joint nerve blocks, with a strong strength of recommendation to avoid opioids. 
  • The level of evidence is moderate showing that benzodiazepines do not affect the validity of diagnostic facet joint nerve blocks, with moderate strength of recommendation that they may be utilized for mild sedation in low doses based on the patient’s physical and medical status.
  • The level of evidence is strong that mild sedation may be required and utilized during the performance of diagnostic facet joint interventions, with moderate strength of recommendation to provide sedation during therapeutic interventions. 
  • The level of evidence is strong that the prevalence of facet joint pain and false-positive results may be higher in patients with involvement of multiple regions, lower in post-surgical syndrome, and higher in the older population, with moderate strength of recommendation to consider these factors in providing appropriate diagnosis and therapy. 

Moving on to the section Therapeutic Facet Joint Interventions

  • The level of evidence is moderate with moderate strength of recommendation for the clinical effectiveness of cervical radiofrequency ablation. 
  • The level of evidence is strong with weak to moderate strength of recommendation for the clinical effectiveness of thoracic radiofrequency ablation. 
  • The level of evidence is moderate with moderate strength of recommendation for the clinical effectiveness of lumbar radiofrequency ablation. 
  • The level of evidence is strong for short-term improvement and consensus-based for long-term improvement, with weak strength of recommendation for the clinical effectiveness of cervical intraarticular facet joint injections.
  • The level of evidence is strong with weak to moderate strength of recommendation for the clinical effectiveness of thoracic intraarticular facet joint injections. 
  • The level of evidence is limited with weak strength of recommendation for the clinical effectiveness of lumbar facet joint intraarticular injections.
  • The level of evidence is moderate with moderate strength of recommendation for the clinical effectiveness of therapeutic cervical facet joint nerve blocks. 
  • The level of evidence is moderate with moderate strength of recommendation for the clinical effectiveness of thoracic therapeutic facet joint nerve blocks.
  • The level of evidence is moderate with moderate strength of recommendation for the clinical effectiveness of therapeutic lumbar facet joint nerve blocks. 

Then the section on Special Considerations

  • The level of evidence is moderate with moderate to strong strength of recommendation for the safety and effectiveness of repeat facet joint interventions, including radiofrequency ablation, or RFA, with outcomes similar to the initial procedures. 
  • The level of evidence is moderate with strong strength of recommendation regarding the impact of temperature, duration of lesioning, and lesion size when performed with an 18-gauge needle in the lumbar spine and a 20-gauge needle in the cervical and thoracic spine, utilizing an active tip of 10 mm in the lumbar spine and 5 or 10 mm in the cervical and thoracic spine. 
  • The level of evidence is limited, with no specific recommendation regarding the use of a particular type of electrode or needle for RFA. 
  • The level of evidence is limited, with weak strength of recommendation regarding differential effectiveness based on electrode positioning, either parallel or perpendicular to the nerve. 
  • The level of evidence is moderate, with strong strength of recommendation to perform motor and/or sensory testing before RFA.
  • The level of evidence regarding safety is limited, with weak strength of recommendation to perform RFA cautiously in patients with metallic implants. 
  • The level of evidence is strong with moderate strength of recommendation for the safety and effectiveness of RFA, including bipolar RFA, and maintenance of a distance of 15 cm or 6 inches, in patients with cardiac pacemakers who have undergone appropriate pretreatment preparation with all necessary precautions.
  • The level of evidence is moderate with moderate to strong strength of recommendation in patients with cardiac pacemakers to treatment with therapeutic facet joint nerve blocks instead of RFA.

Moving on to the section on Radiofrequency Ablation in Patients with Stimulators and Intrathecal Infusion Systems

  • The evidence regarding safety is strong to consensus-based, with weak strength of recommendations for the performance of RFA, including bipolar RFA, and maintenance of a distance of 15 cm or 6 inches in patients with implantable stimulators and intrathecal infusion systems using appropriate safety precautions. 
  • The level of evidence regarding safety is consensus-based with weak strength of recommendation to perform RFA, including bipolar RFA, in patients with stimulators and pumps implanted in the cervical spine, including hypoglossal nerve stimulators, vagus nerve stimulators, and cervical leads, using appropriate safety precautions. 
  • The level of evidence including bipolar RFA and maintenance of a distance of 15 cm or 6 inches is moderate with moderate to strong recommendation regarding the performance of therapeutic facet joint nerve blocks as a substitute for RFA in managing spinal facet joint pain in patients with stimulators and pumps, including hypoglossal nerve stimulators, vagus nerve stimulators, and cervical leads, specifically in the cervical and thoracic spine. 

Next the section on Antithrombotic Therapy

  • The level of evidence regarding safety of facet joint interventions, including intraarticular injections, medial branch blocks, and ablation, is strong with moderate strength of recommendation that antithrombotic therapy may be continued based on ASIPP Antithrombotic Guidelines.

And last the section on Sedation

  • The level of evidence is strong that mild sedation and analgesia may be required and utilized during the performance of therapeutic facet joint interventions, with moderate strength of recommendation. 
  • The level of evidence is strong that moderate sedation or monitored anesthesia care may be required for RFA, with moderate strength of recommendation. 

And there you have it. Make sure to check out the full guideline from the American Society of Interventional Pain Physicians and other related clinical decision support tools at guidelinecentral.com.

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