The facet joints are paired structures that lie on the posterolateral aspect of the vertebrae. Innervation derives from the medial branch, which stems from the primary dorsal ramus of the spinal nerve. It is complex yet predictable, with each joint receiving dual innervation from contiguous medial branches at and above level. Consequently, when performing medial branch blocks (MBB) for the treatment of pain from one joint, two nerves must be blocked. Facet-mediated pain is mainly axial and exacerbated by loading and motion, particularly spine extension. Medial branch blocks seem to provide sustained pain relief, improved function, and employment status in some patients (14–16 weeks) and are used by some as therapeutic injections, even though no decrease in opioid consumption has been seen.