With up to 70% of people worldwide experiencing back pain at some point in their lives, a proper diagnosis is key to successful treatment. In some cases, the diagnostic tools we use to identify these underlying conditions can double as treatment options. Medial branch blocks are one such treatment approach. Here’s what you should know.

What is a medial branch block?

Medial branch blocks are minimally-invasive injections of an anesthetic and a steroid into affected areas of your spine. They’re used as both a treatment and a diagnostic tool for pain in the back and neck.

The spine consists of 33 vertebrae separated by fluid-filled intervertebral discs. Each vertebra has bony protrusions on either side of the spinal column – two extending up and two extending down. These bony protrusions connect the vertebrae and allow the spine to twist and bend. Known as facet joints, the area where these bones connect is lubricated with synovial fluid and a thin layer of cartilage that allows smooth movements of these joint.

The entire structure of the vertebrae, including the facet joints, surrounds the delicate nerves of your spinal cord. The medial branch nerves themselves pass through the facet joints to send signals to your brain. If any part of a facet joint is injured or begins to deteriorate, the resulting pain signals go straight through these medial branch nerves through the spinal cord and up to the brain.

Facet joint pain can occur in any region of the spine, from the cervical spine in the neck all the way down through the thoracic spine in the middle of the back to the lower back (lumbar spine).

How can a medial branch block help me?

A medial branch block numbs the medial branch nerves that thread through the facet joints, stopping pain signals from reaching the brain. Effectively, as the name suggests, they “block” pain signals.

A medial branch block is used most commonly to treat facet joint pain (sometimes referred to as facet joint syndrome). Inflamed facet joints can cause soreness, pain, and stiffness that increases with prolonged sitting and standing. These injections can block pain and reduce inflammation in the area and, in that way, help relieve your symptoms.

For patients who are experiencing back pain but have not yet received a diagnosis, medial branch blocks can be a helpful diagnostic tool. If the injection results in pain relief, facet joint syndrome is usually the diagnosis. These patients can then get medial branch blocks at regular intervals to reduce their pain while they go through other therapies (like physical therapy or chiropractic care) to reduce their pain long-term.

When patients receive a medial branch block and still feel pain, then it’s time to look for another underlying cause.

Medial branch block risks

Medial branch blocks are not for everyone. If you are allergic to the anesthetic injected during the procedure, serious complications can arise. You should avoid this procedure. Patients taking blood-thinning medication (e.g., coumadin or injectable heparin) or anti-platelet drugs like Plavix may need to stop use prior to the procedure, under the direction of their doctor.

Patients who are experiencing an active infection anywhere in their body will also be ineligible until they resolve the infection.

If you are pregnant (or suspect you might be), you should also talk to your doctor about risks. A medial branch block procedure may not be for you.

What can I expect during a medial branch block procedure?

During your medial branch block procedure, our main focus is your comfort. At Alliance Pain Solutions, our goal is to alleviate your pain with the most conservative care that results in positive outcomes.

For medial branch blocks in the lower back and mid-back areas, we can perform the procedure with you positioned on your side. For cervical (neck) medial branch blocks, you will lie comfortably face down.

We use a topical anesthetic to numb the area to be injected. Using fluoroscopic guidance, we inject an anesthetic such as lidocaine and a steroid to help reduce inflammation.

You may experience one of several different results:

  1. No pain relief: This means that the issue is not with your facet joint and we’ll have to look at other possible origins for your pain
  2. Pain goes away briefly but returns: This could indicate that the facet joint is the issue but another more interventional procedure may provide better pain relief
  3. Pain goes away, comes back, and then gradually improves: In this case, the medial branch block may be your best treatment

If a medial branch block procedure is used for pain relief, your doctor will limit injections to no more than six per year. For diagnostic purposes, four injections per year is the general guideline.

Medial branch block recovery time

Medial branch block recovery time is brief. Barring complications or rare side effects (listed below), you can return to normal activity the day after your procedure.

Medial branch blocks are generally safe, but as with any medical intervention, there is a risk of side effects. Mild and common side effects include soreness and bleeding at the injection site. This can last for up to seven days. You can treat this with an ice pack and light compression for 15 minutes at a time. Limit physical activity and rest on the day of your procedure to give yourself time to recover.

More serious but rare side effects include:

  • Infection
  • Nerve injury
  • Allergic reaction
  • Seizure
  • Stroke
  • Injury to blood vessels
  • Hematoma

These are very rare. If you experience weakness that lasts longer than a day, fever, or swelling, give your doctor a call, as this can indicate a potentially serious complication. Should you experience extreme shortness of breath or coughing, chest pain, increasing swelling at the injection site, or complete numbness below the waist, visit your nearest emergency room immediately.

Side effects and complications are minimized when a skilled and experienced practitioner performs medial branch blocks. Alliance Pain Solutions is a West Phoenix pain management clinic that welcomes patients from all over the Valley. We have advanced experience using medial branch blocks to help our patients relieve pain.

If you have questions about medial branch blocks or need help managing your pain, get in touch today.

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