Facet and sacroiliac joint arthropathy are common, specific causes of low back pain. With a combination of a focused physical examination and image guidance, pain originating from these joints can be accurately targeted and these joints respond well to the direct application of long-acting deposition preparation steroids. When routine steroid treatment of the facet joint is not effective and more advanced treatment is required, denervation of the facet joint through the use of radiofrequency ablation (RFA) is a preferred method. Image guidance is a critical tool in targeting facet joint innervation, performing a central role in the techniques used in both preprocedure testing and the RFA treatment. This article reviews the basic image-guided fluoroscopic and computed tomographic-guided approaches to steroid treatment of the facet and sacroiliac joints and further discusses of the painful facet through RFA.