Chronic neck and back pain are debilitating conditions that affect millions of people every year. When a course of rest, non-steroidal anti-inflammatory medicine, and other lifestyle pain management treatments doesn’t work, doctors and patients look to other therapies for help. Medial branch blocks are a way to not only manage chronic neck or back pain but to also diagnose it. What is a medial branch block and how does it work?
What is a medial branch block?
Medial branch blocks are minimally-invasive spinal injections. That’s the short answer. They are similar to other types of spinal injections in that they often use a numbing medicine along with an anti-inflammatory medicine to control both pain and inflammation. This procedure is typically performed in an outpatient capacity and is considered a non-invasive alternative to surgery with few side effects.
Medial branch blocks differ from other types of spinal injections in that they are also used as a diagnostic tool. This is related to how and where the injection is delivered and can be a valuable pain-relieving tool.
Injury or trauma on facet joints in the neck and back may account for 45% of pain experienced by adults in the United States. It is important that specialists understand how to treat this pain effectively and quickly to restore balance to the lives of their patients. Medial branch blocks offer a minimally-invasive option for pain specialists to do so.
Anatomy of medial branch blocks
To understand how medial branch blocks can serve as diagnostic tools, it is important to know a little bit about anatomy. Facet joints are the joints located between the vertebrae. They are also on each side of the cervical vertebrae and along the ridges of the lumbar spine. These joints are lubricated and cushioned with synovial fluid. This fluid allows the bones to slide smoothly across each other. To make movement more comfortable, each facet joint is also surrounded by a thin layer of cartilage.
The vertebrae, including the facet joints, surround the delicate nerves of the spinal cord. The medial branch nerves come out of the facet joints. These nerves are responsible for sending signals to the brain.
When any part of this joint – the joint itself, the synovial fluid, or the cartilage – becomes damaged or begins to deteriorate, pain and inflammation can result. As deterioration continues, the medial branch nerves send signals of pain to the brain. Increasing pain and decreased range of motion are very common as joints continue to decline.
Watch the procedure — a medial branch block video
Medial branch blocks are injections delivered directly into the facet joint. Patients lie face down on a table. The area to be injected is cleaned and sterilized. Guided by fluoroscopy, the pain management specialist will inject the spine with a local anesthetic (e.g. lidocaine) and a steroid (if using).
To avoid pain during the procedure, a local anesthetic will be injected to numb the area around the block. This will involve a small needle and you may feel a prick and a burning sensation before the medication begins working, however, there is normally little pain associated with the procedure. Some patients may request sedation if they are anxious about the procedure, but in general patients receive only a local anesthetic.
The procedure itself only takes a few minutes but patients should plan for an hour for the pre-procedure prep and recovery observation for a short period of time after the injection. If you do choose to use a sedative the appointment will take longer and you will need to make sure you have a driver and caretaker once you are home.
Patients will rest briefly after the procedure and can continue with their normal activity shortly afterwards. This recovery time will vary, depending on whether or not sedation was used. In general, most patients are able to return to full activity within a few days.
To see more, watch the medial branch block video below.
What are medial branch block benefits?
Medial branch blocks can offer immediate pain relief for those patients for whom it works. This pain relief can allow patients to begin physical therapy or exercise routines to strengthen supporting muscles in the back and abdomen. Medial branch blocks are helpful for:
The medial branch nerves enervate the muscles of the back, and this type of injection can help target those sites directly.
Medial branch blocks resulted in significant pain relief according to a study published in 2006. This study found that 71% of patients reported a decrease in pain and increased functionality that remained stable over three years.
Another study in 2012 found similarly positive results with or without steroids. As steroid injections may lead to bone loss and weakened connective tissue over time, steroid-free medial branch blocks may be an excellent treatment option for patients with osteoporosis.
One of the benefits of medial branch blocks is their use as a diagnostic tool. If the cause of pain is not able to be identified, medial branch blocks can help. If a patient experiences pain relief after an injection, the cause of pain is most likely disc degeneration or injury at the site of the injection. Further, if pain is unrelieved after the injection, then the pain management specialist knows to keep looking for the cause.
If medial branch blocks accurately identify the source of the pain, patients may then choose to undergo another procedure called radiofrequency ablation. Once the nerves causing pain are identified with a medial branch block, radiofrequency ablation uses a high-frequency electrical current to disrupt pain signals from those nerves, resulting in longer-lasting pain relief.
Conditions treated with radiofrequency ablation
Radiofrequency ablation is particularly effective in treating trigeminal neuralgia. Trigeminal neuralgia is a pain condition that causes sharp jolts of pain in the face. Other conditions that are treated by radiofrequency ablation include:
- Lumbar facet pain
- Cervical facet pain
- Dorsal root ganglion pain caused by a herniated disc
- Lumbar spine pain caused by sacroiliac joint complex
- Sympathetic ganglia
- Sphenopalatine ganglion pain (headache and atypical facial pain)
In general, medial branch blocks are a safe, effective way to not only treat many different types of back pain but to also diagnose the cause of the pain. This can lead to longer-term pain relief in the form of radiofrequency ablation. To learn more about radiofrequency ablation, you can watch the following procedure video.
How long does a medial branch block last?
Medial branch blocks often only last for a short amount of time, however, they are often used to diagnose affected areas that will then be treated with other longer lasting interventional procedures, such as radiofrequency ablation or epidural steroid injections.
For pain relief, no more than six medial branch blocks should be administered annually. If medial branch blocks are being used diagnostically, patients should receive no more than four in one year.
Are there medial branch block side effects?
Any medical procedure comes with risks and patients should educate themselves to be aware. Medial branch blocks are considered a minimally-invasive procedure and thus have few side effects. Most of the side effects are mild, lasting only a few days. They may include soreness and bleeding at the injection site. These medial branch block side effects can last up to a week. More rare side effects can include:
- Allergic reaction
- Nerve damage
These more rare side effects may be due to improper needle placement, a condition that can be prevented with careful use of fluoroscopic guidance of the needle. Working with a highly-trained pain specialist can ensure you have access to the best treatment methods.
You likely have questions beyond “What is a medial branch block?” More than likely, you’re most interested to see if one could help you reduce your pain.
While medial branch blocks are a minimally-invasive, safe procedure, there are still some tests your doctor will need to run before performing one. And, well-trained pain specialists will try medial branch blocks after more conservative treatments like physical therapy have failed to work. Once they’ve confirmed that you’re a good candidate for a medial branch block, they’ll work closely with you to help you prepare for the procedure and find pain relief after.
To find a pain specialist in your area, click the button below. Our PainDoctor.com certified pain specialists are experts at relieving pain and finding the most suitable pain treatments for their patients. They can also answer any more questions you have about the procedure.