Medial Branch Block – Performed by a top Rochester Hills Pain Management doctor
Medial Branch Block is a diagnostic procedure is performed to identify a painful facet joint. The facet joints are the joints between the vertebrae in the spine. They allow the spine to bend, flex and twist.
A medial branch nerve block is a procedure where a local anesthetic agent is injected close to small medial nerves which are connected to specific spinal facet joints. Several levels of the spine are typically injected during the course of a single procedure. If a patient realizes significant relief from their level of pain immediately following the injection, then the facet joint is considered to be the primary source of their pain.
The medial branch block is primarily a diagnostic procedure. In other words, if a particular patient experiences an appropriate length of pain relief after administration of a medial branch block they may be considered an ideal candidate for a subsequent procedure, known as a radiofrequency neurotomy (ablation). This treatment technique provides longer term relief from the pain associated with facet joints.
Recent Study Shows Medial Branch Blocks Provide Effective Pain Relief
A 2008 randomized control trial was conducted in the U.S. to ascertain the clinical effectiveness of local anesthetic medial branch blocks (with or without steroidal medication) in the therapeutic management of chronic cervical neck pain originating in facet joints. This double-blind study involved 120 participants. Using 60 patients in the local anesthetic group l, the researchers also used the same number of people in the steroid group ll.
Group I participants were injected with medial branch blocks containing only bupivacaine. Group II participants were administered branch blocks consisting of both bupivacaine and a steroidal medication. Pain scores, neck disability levels, opioid use, and work attendance were evaluated at the baseline mark, three month, six month, and twelve month marks.
“These experts concluded that medial branch blocks administered with local anesthetic agents were valid. Medial branch blocks identified sources of pain in 85% of patients”
Marked relief of pain (greater than or equal to 50%), as well as improvements in functional status, were noted at the three month, six month, and twelve month marks in more than 83% of study participants. The average treatment numbers, over the course of one year, was 3.5 plus or minus 1.0 in the non-steroidal bupivacaine group and 3.4 plus or minus 0.9 in the steroidal group.
Pain relief lasted for 14 plus or minus 7 weeks in group l. In group ll, pain relief lasted 16 plus or minus 8 weeks. Significant degrees of pain relief and improvements in functioning were reported to last anywhere from 46 to 48 weeks over the period of one year. This study concluded that therapeutic medial branch nerve blocks, both with or without steroids, may provide effective management of chronic cervical pain originating with the facet joints.
American Society of Interventional Pain Physicians Guidelines
The American Society of Interventional Pain Physicians compiled certain guidelines on chronic pain management techniques. This included a review of randomly controlled clinical trials concerning the diagnostic use of medial branch nerve blocks. These experts concluded that medial branch blocks administered with local anesthetic agents were valid. Medial branch blocks identified sources of pain in 85% of patients. In addition, it was stated that:
- Evidence demonstrates that medial branch blocks provide diagnostic assistance in investigations of cervical pain experienced by adults.
- This procedure has shown to be safe, valid, relatively accurate as well as clinically valuable in diagnosing chronic cervical neck pain.
- Accurate evidence of this procedure was provided by one systematic review study, one guideline, two comparative studies along with six experimental studies.
- Comparative and experimental studies, which included 555 enrollments, supplied additional information specific to pain prevalence, false positives as well as utility potential, diagnostically speaking.
Resources:
spine-health.com/treatment/injections/medial-branch-nerve-blocks
ncbi.nlm.nih.gov
acc.co.nz/for-providers/clinical-best-practice/interventional-pain-management/interventions/nerve-blocking-procedures
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