Nerve blocks
This is a treatment which offers short term relief of pain generally lasting from a few days to a few weeks. The purpose of using nerve blocks is to offer temporary relief, allowing the person to make other changes in their life which can lead to significant long term improvement.
Here is an example of how nerve blocks can help:
Consider Mr. John Smith who is referred into our clinic for chronic back pain.
He has tried physio/chiro/acupuncture/massage/tens but continues to suffer. Over the counter pain and prescription pain medications have been unhelpful. He is unable to exercise and puts on weight. He tends to eat comfort foods which are often inflammatory. His sleep is impaired. He is unable to perform duties around the house. His relationships, both at work and at home suffer. He becomes depressed and feels hopeless. He is unable to work and ends up unemployed or on disability.
His health care workers have repeatedly encouraged him to exercise and lose weight, but he is unable to do so because of chronic back pain. His physiotherapist has prescribed a stretching and strengthening routine but despite several treatments he has not made any progress because he is unable to properly do the exercises. He is in a ‘Catch-22” situation whereby the back pain prevents him from doing the very things that would improve his pain.
He is started on nerve blocks. Initially this provides him a few days to a few weeks of pain relief. It is just enough, however, to get him to start walking every day. Using principals of pacing, he gradually increases his walking distance by setting specific goals. He engages in core strengthening. His increased exercise is coupled with better food choices. Many chronic pain sufferers eat ‘comfy carbs’ because it gives them a brief reprieve from the burden of chronic pain. By reducing the pain, patients can reduce their reliance on these inflammatory ‘comfy carbs’. Through increased activity and increased goal setting, he is encouraged to make other changes in his life. He is more likely to contribute around the house. He is less irritable. Relationships with family members improve. Pain relief coupled with sleep hygiene offers him a better night’s rest. This leads to less fatigue during the day allowing for more exercise.
Eventually, as he makes positive changes in his life, he loses weight, builds core strength, and notes an improvement in mood. Nerve blocks which were initially administered every 1 to 3 weeks are then weaned off.
In my 15 years of practice, I have seen this many times. It should be noted however, nerve blocks or any medical treatment for that matter, will not produce long term relief unless that patient makes changes to their lifestyle.
I often tell my patients “These injections will relieve your pain, but it is what you do with that pain relief that determines your long term outcome.”
Nerve blocks are generally done further away from the spinal cord after the nerve exits the spinal canal. Sometimes, depending on the source of the pain, more invasive procedures are required whereby the needle is placed within millimeters of the spinal canal. I usually do not perform these procedures and I refer them to our experienced anesthesiologists.
This is a treatment that is specifically meant to treat sciatica. Sciatica (pain down the leg) generally occurs when a herniated disc presses on the nerves of the lower lumbar spine. Usually at L4/L5/S1. By injecting steroid into the epidural space that surrounds the spinal cord, it may shrink the disk. Epidural injections are usually administered by an anesthesiologist who has performed this hundreds of times. Most of the time, this is done right in the clinic however patients must bring someone to drive them home.
Transforaminal Epidural Steroid Injection
This is similar to an epidural injection but the needle is inserted into the epidural space through a different approach. This technique requires fluoroscopy.
Medial Nerve Branch Block and facet joint injection
The vertebra sit on top of each other and are linked by the facet joints. Often, arthritis can develop at these joints causing chronic back pain. As opposed to sciatica, the pain is limited to the back or the upper leg. There are 2 ways to address this pain. Sometimes, you can directly administer steroid to the joint. Much like a knee joint, inflammation and arthritis can settle with a steroid injection. Sometimes, a more invasive but potentially longer lasting treatment is indicated. The nerve that provides sensation to the facet joint (called the medial nerve branch) can be severed through ablation. This can often produce relief lasting for months to over a year. Most patients are given a ‘diagnostic’ injection first whereby the nerve is temporarily frozen with a local anesthetic. If the patients get good relief then the patient undergoes a second procedure resulting in ablation of the nerve.