The facet joint is a true synovium-lined joint located in the posterior compartment of the spine that allows the spine to flex, extend, and rotate. The major causes of facet mediated back pain are osteoarthritis, erosions of the adjacent bone margins of the facets, bony overgrowth of the facets and articular processes, degenerative conditions resulting in reduction or loss of facet joint cartilage, or acute causes such as instability of the joint itself after trauma such as a motor vehicle accident. Facet pain is often an under diagnosed cause of back pain. However, the prevalence of facet joint mediated pain in patients with chronic spinal pain has been established as 15 to 40% of lower back pain.1-3 Facet mediated pain is more common in the elderly than the younger population. Once there is suspicion of facet mediated pain, the clinician then must decide to proceed with purely diagnostic medial branch blocks with local anesthetic or diagnostic and therapeutic intra-articular facet blocks with steroids. The clinician must also keep in mind that typically facet disease is not often limited to only one joint. This chapter will discuss the indications to perform intra-articular facet joint injections and median branch blocks and the proper techniques used in performing the procedures.