If you’re experiencing back or neck pain that hasn’t been relieved by medications or physical therapy, your doctor may recommend other treatment options. A medial branch block may be the next step in diagnosing and treating pain if the doctor suspects problems with a facet joint.
A medial branch block is a procedure that blocks pain signals from a facet joint. Facet joints connect the bones in the spine, letting the neck and back bend and twist. However, these areas can cause significant joint pain if damaged by injury, arthritis or another cause.
Each facet joint connects to medial branch nerves that send pain signals to the brain from a damaged facet joint. A medial branch block is a procedure where a doctor blocks these nerves. This is often done by injecting a numbing medication directly into the nerves.
A medial branch nerve block prevents the affected nerves from sending pain signals to the brain. When the nerves from a painful facet joint are blocked, the patient will experience pain relief.
The doctor sometimes blocks medial branch nerves by injecting an anesthetic near the facet joint to numb the nerves. After applying a local anesthetic to reduce injection-related pain, the doctor will insert a needle into the medial branch nerves to inject the numbing medicine. The doctor may use X-ray guidance to ensure correct needle placement. Numbing the painful nerves helps alleviate the patient’s pain.
These injections usually offer only short-term relief and are often used to determine whether a more permanent nerve blocking procedure is appropriate. If medial branch nerves are the source of pain, the doctor may recommend radiofrequency ablation.
Radiofrequency ablation uses heat produced by a radio wave electrical current to destroy nerve fibers. As with numbing, destroying the nerves prevents them from sending pain signals to the brain, but the effects last longer. During radiofrequency ablation, the doctor inserts small needles into the nerves. These needles deliver the current and heat to destroy the nerve fibers.
You have neck or back pain that hasn't been relieved by medications or physical therapy.
You have pain stemming from your facet joints.
You have a systemic infection or substantial bleeding diathesis.
Medial branch blocks can lead to effective management of back and neck pain. These nerve treatments can be a promising option for people who haven’t gotten enough pain relief from medications or other therapies.
Although the relief from medial branch block injections isn’t usually long-lasting, the procedure is an effective diagnostic tool. Doctors can efficiently and accurately determine whether the nerves related to a particular facet joint are the source of back pain. These injections tell the doctor how to proceed with treatment and whether a radiofrequency ablation is appropriate.
Radiofrequency ablations are quite effective in alleviating back and neck pain for many people. Around 65% of people report more than a 50% reduction in back pain in the two years after a radiofrequency ablation. Radiofrequency ablation has also been shown to improve neck pain, employment ability and psychological well-being.
Doctors may recommend a medial branch block if they suspect that a facet joint is causing pain. A medial branch block may be appropriate if other measures, such as physical therapy or anti-inflammatory medications, don’t relieve back pain. Doctors also use medial branch blocks for neck pain caused by cervical facet joints in the neck.
A first medial branch block is often used for diagnostic purposes. The doctor may want to confirm that a particular facet joint is the cause of pain before recommending long-term treatments.
If numbing the medial branch nerves by injecting an anesthetic relieves the patient’s pain, the doctor can confirm that the facet joint and medial branch nerves are the cause. However, even an effective initial diagnostic numbing injection may only provide a few hours of pain relief. If the injection doesn’t affect the patient’s pain, the doctor knows to keep exploring the problem.
Medial branch blocks can also provide long-term relief from back or neck pain for many people. Although a single anesthetic injection doesn’t offer lasting pain treatment, a doctor may recommend multiple injections over time for longer-lasting effects. A doctor may also provide more permanent pain treatment by blocking the medial branch nerves with radiofrequency ablation.
The most common side effect of medial branch blocks done by injection is soreness around the injection site. This soreness usually lasts only a few days. More serious side effects can include:
These side effects are rare. A skilled physician can further reduce the chances of side effects by using X-ray guidance and sterile tools.
Radiofrequency ablation of the medial branch nerves also carries the potential risk of allergic reaction, bleeding and skin irritation. Rarely, the procedure may cause heat damage to nearby body parts or unwanted nerve damage.
You should discuss your treatment options and medical history with your doctor before any procedure. Some medications, including blood thinners, can increase the risk of side effects. A doctor may recommend that these medications be temporarily stopped for a period of time before a medial branch block procedure.
A medial branch block is a quick outpatient procedure. The procedure itself usually takes about 15 minutes. Although there may be some mild soreness at the injection site, there is no need for recovery.
In fact, doctors typically recommend that normal activities be resumed right away, and there is no need to rest. Returning to normal activities lets patients accurately compare their pain levels before and after the procedure, which is essential for diagnostic purposes.
Radiofrequency ablations require more recovery because they may involve the use of anesthesia. The doctor may want to keep the patient for observation for several hours, but this is still an outpatient procedure. Patients should usually avoid high-intensity activities for a few days. Most people experience significant pain relief within one to two weeks.
Northeast Spine & Sports Medicine provides convenient access to experienced pain management professionals with multiple locations and online appointment booking. Contact us today to discuss treatment options.