Why facet joints are only one possible source of back pain, how they are assessed, and when diagnostic blocks may be relevant.
Consultant Radiologist and Interventional Pain Specialist • Updated 16 September 2026
Facet joints can contribute to localised spinal pain, but symptoms overlap with many other causes. There is no single scan finding that proves a facet joint is painful. Diagnosis is clinical and, in selected cases, may involve a diagnostic medial branch block.
Facet joints are small joints at the back of the spine that guide movement and help provide stability. Like other joints, they can develop age-related changes.
Possible patterns include localised back pain, stiffness, pain with extension or rotation, and discomfort that may spread into the buttock or upper thigh. These features are not specific enough to make the diagnosis alone.
MRI or CT may show facet arthritis, but structural change does not prove that the joint is the source of symptoms. Imaging is useful mainly to understand the wider anatomy and exclude or identify other causes.
For selected patients with chronic localised back pain after non-surgical treatment, NICE allows referral for assessment for radiofrequency denervation when pain is thought to arise from structures supplied by medial branch nerves. Radiofrequency denervation should only follow a positive diagnostic medial branch block.
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No. Arthritis can be present on imaging without being the main source of pain.
No. A medial branch block targets the nerves supplying the facet joints and is used diagnostically in selected pathways.
No. It helps improve patient selection, but no procedure can guarantee benefit.
This article is general information and does not replace an individual medical assessment.
If pain is affecting your sleep, work, mobility or confidence, a specialist assessment can help clarify what is happening and what the sensible next step should be.
