Relieving spinal nerve pain can take a long time, and it may take the time you can’t afford to take, especially if you have to work to support your family. There are three types of nerve blocks that can take away spinal nerve pain semi-permanently. If you have a degenerative disc disease, or you’ve sustained an injury, or have arthritic changes that have caused you to suffer from discogenic pain, and you don’t have weeks to recover ask spine doctors in texas about one of these nerve blocks.
The first block I will mention is the nerve block is a nerve root block, the second is the joint block, and the last is the radiofrequency nerve block. If you were to have a pinched nerve in the neck it would be called a cervical nerve root block, and if it was in the thoracic region it would be called a thoracic nerve root block, and the same for the lumbar and sacral regions. The same is true with the other nerve blocks I will tell you about; the only difference is the location of the blocks. There is no difference in how they are performed. For anyone of these procedures if the doctor uses conscious sedation for anesthesia you will not be able to drive home, so it is imperative that you bring someone with you the day of the procedure. When you return home from the procedure you will need to take it easy for the first 24 hours and then gradually increase your activities over the next couple of weeks. In all three nerve blocks you may be asked to keep a pain diary to record your level of discomfort if any. You may be asked to bring your pain diary with you to all your follow-up appointments.
Nerve Root Bloc
The nerve root block is the epidural I wrote about in another article. Some doctors give the injection right in their offices, but it is better to give it in an outpatient facility under conscious anesthesia. If conscious anesthesia is given, an IV will be started to keep a vein open for more sedation if needed. The IV line is also beneficial for an emergency route to deliver medications if your blood pressure starts to fall drastically. Most patients don’t have a problem with nerve blocks but there is always a small risk of going into shock.
The epidural anesthetizes the nerve root which is located in the epidural space within the vertebra. To be absolutely sure of the placement the doctor should use a moving x-ray (fluoroscopy) to help guide the needle into the epidural space. (The epidural isn’t always done with fluoroscopy, but it is the most accurate way to ensure needle placement.) During the procedure your heart will be monitored with an EKG, and your blood pressure, and respiratory rate will be recorded throughout the duration also. The doctor will then inject a few drops of contrast medium, which is a dye that will show up on the fluoroscopy screen. When the placement is confirmed, the doctor will inject a mixture of lidocaine and a corticosteroid anti-inflammatory such as cortisone or Depo-Medrol. The block will be injected very slowly into the epidural space. When the nerve root block has been delivered the patient will be in recovery for about 30 minutes. After the recovery phase you will be assisted up to your feet so you can go home.
The nerve root block is indicated if your pain extends farther than what is usual for nerve pain. For example if with a pinched nerve in the neck you were feeling pain, tingling, or numbness that extended past the shoulders and down into the ribs or down the legs this would be an indication of nerve root involvement. If you had a pinched nerve in the lumbar spine and you felt pain, numbness, and tingling down in the back of the knee cap and down to the lower legs, this too is an indication of nerve root pain.
Facet Joint Block
The facet joint block is similar to the nerve root block, but the needle does not target the nerve root specifically. With a facet joint block the doctor inserts a needle into the facet joint. You will be able to see a film about that if you click on my first source. Facet joint blocks are indicated if you are having pain and tenderness in the neck, thoracic region, or in the lower back. You may have persistent pain that radiates from the neck and back to the buttocks and lower extremities.
The bony prominences of the vertebral column are the facet joints, and those surfaces are lined with cartilage, tendons, and muscles. Facet joint pain most often occurs in the neck and lower back. With cervical (neck) facet joint pain you may have referred pain that radiates to the shoulders, and down the arms. With lumbar facet joint pain you may have referred pain that radiates down to the buttock and thighs.
The doctor injects the facet joint with the same kind of injection mentioned above in the nerve root block. The only difference is it is injected into the facet and not further into the epidural space; specifically it is an injection guided by fluoroscopy. The contrast medium confirms the placement of the needle. Then an injection of numbing medicine and corticosteroid is injected slowly into the joint. Once the injection is given there is a recovery phase just as in the first block mentioned.
Radiofrequency Lesioning (Nerve Block)
The radiofrequency lesioning is similar in one way to the other two blocks and that is that you are put under conscious sedation, and the procedure is done with the aid of fluoroscopy. That is where the similarities end; the big difference between radiofrequency and the other two nerve blocks is that two needles are inserted into the nerve roots. There are two needles because there are two nerves that send impulses. The two needles are guided into the facet joint near where the nerves are located. An electrical current is supplied by a radiofrequency machine until the nerve stops sending signals. This procedure may take about an hour. The results are semi-permanent, meaning you will be pain-free for 6 months to a year.
All of the nerve blocks mentioned in this article are treatments for pain only. They are not a cure. With the symptom of pain gone the patient can then get on with his/her life without long periods in rehab or out of work.
