Millions of people are suffering from back and neck pain every year. Although many of these people improve and even see a complete elimination of their pain, not every pain sufferer has this experience. A small, but significant number of people have their back and neck pain turn into chronic pain issues. There may be multiple causes to this pain, but the one thing that everyone tends to have in common is that the facet joints of the spine are causing the pain.
A medial branch block helps to stop this pain through the physical destruction of the nerves that are sending the signals. There are some advantages to having such a procedure, but there are some distinct disadvantages as well. Here are some of the pros and cons of a medial branch block to consider.
The Pros of a Medial Branch Block
1. It can eliminate pain on a permanent basis.
When someone is suffering from facet joint pain, it can be very debilitating. The pain can wrap around the ribs, come into the chest, and create a painful tenderness because the joint becomes inflamed. This pain can even go into the arms, legs, or face and cause muscle spasms at time as well. It can even become the cause of migraine-style headaches. The medial branch block takes this pain away.
2. Recovery times are remarkably fast.
It only takes about 60 minutes for a patient to recover from a medial branch block procedure. Much of the procedure occurs while the patient is awake as well so that nerve issues can be adequately tracked. The procedure itself is rather painless, outside of a desensitizing of the nerves through a local anesthetic at the outset of the procedure.
3. It becomes easier to participate in therapies.
Whether the procedure creates a permanent fix or just a temporary one, many people who have a medial branch block procedure completed find that their pain has reduced enough to participate in various therapies. Over time, these therapies can help to naturally insulate the nerves from further pain transmissions to the facet joints so the pain issue can resolve itself. Even if it doesn’t put the pain into complete remission, the physical therapies create better long-term treatment success odds.
4. Relief is often immediate.
The injection which occurs for the medial branch block can provide instant and immediate relief from pain. It is so profound, in fact, that doctors can eliminate a specific nerve cluster or branch as causing the issue of immediate pain relief is not experienced. This creates a win/win situation for the patient. They’ll either stop feeling the chronic pain or they will have their diagnosis narrowed down so that they can soon stop feeling chronic pain.
5. False positives are generally low.
Even when single blocks are being used to create relief, the false positive rates of this procedure are relatively low. In some studies, it has been as low as 17%. The best results tend to come from doctors who are using specific criteria in order to define the chronic pain and how much pain relief is being experienced.
6. 90% pain relief can be achieved.
Although most patients generally have between 50-80% pain relief when the medial branch block is effective, some patients can receive up to 90% pain relief on an ongoing basis. The results often last for 12 months or more and some patients report that they go on to experience complete remission.
The Cons of a Medial Branch Block
1. The nerves that are destroyed may never repair themselves.
The nerves that are sending pain signals will no longer send those signals with this procedure, but it isn’t usually a temporary treatment. Even if the facet joints are able to heal and not cause pain any more, the nerves from the medial branch block will not transmit the same data and that can put people at a greater risk of injury because they don’t feel the pain any more.
2. It requires radiation exposure.
The procedure is performed on an outpatient basis and generally takes just an hour to complete. Most procedures occur on an x-ray table while laying on one’s stomach. Continuous x-ray guidance is used to place a radio frequency needle to create the medial branch block. Then motor and sensory tests are conducted to determine if the procedure has been successful.
3. It may cause muscle twitching.
Some people experience motor stimulation that causes their muscles to twitch or thump constantly and without conscious control. This is an indication to the doctor that the block has not been successful and the needle being used will be repositioned. If nerve damage occurs during this process, however, the muscle twitching could become a permanent problem.
4. Not everyone experiences pain relief.
The central nervous system is like the last great unexplored frontier of the human body. Even though medical science has charted the nerves and doctors have an idea of what they can do, each person has a unique body chemistry that has different signals. This means the medial branch block may be 100% ineffective at stopping pain, which means a patient must pay for a procedure that wound up being completely useless. In double blind studies, the pain relief results in the control group were equal to the results experienced by those who didn’t have the procedure performed on them.
5. It may change the location of the pain signals.
Pain signals are still being transmitted by the nerves. The median branch block or the resulting nerve destruction procedures are designed to interrupt those signals, but sometimes the body just reroutes them instead. This means a bothersome pain around the hips might instead become a bothersome headache.
6. There isn’t a gold standard of diagnosis.
Doctors might suspect a facet joint problem and be considering a medial branch block, but they might not actually know what will be the best practices to follow. This is because there really isn’t a set of diagnostic criteria that have been developed to guide doctors towards a definitive diagnosis. This makes it difficult to know exactly when a nerve block should be performed, making the diagnosis more about a doctor’s personal preferences or the patient’s persuasive abilities to influence a medical diagnosis.
Is a Medial Branch Block the Right Choice to Make?
People who receive a positive response from an initial injection may also be viable candidates for a permanent nerve destruction procedure. A single block may also have no benefits at all. When chronic pain is problematic and nothing else seems to be helping, the medial branch block seems to be a no-lose type of procedure. It may not work, but the hope that it could work is enough to consider the pros being stronger than the cons.