What You Need to Know About a Nerve Block Procedure
A nerve block procedure is an injection to decrease inflammation, sometimes prescribed as part of a pain management plan by a pain interventionalist. Typically, medication such as a corticosteroid with or without a local anaesthetic is injected into or around a nerve or into the spine. Nerve blocks aim to lower the sensitivity of the nerves that may be transmitting danger signals – otherwise known as the nociceptive trigger.
Those diagnosed with long-term pain conditions such as neuropathic pain, arthritis, or some types of Complex Regional Pain Syndrome (CRPS) may benefit from a nerve block procedure. This type of local anaesthesia can provide chronic pain relief that is variable in duration. Best results are achieved when combined with appropriate lifestyle changes.
If you’re wondering if a nerve block might work for you, consult with your pain practitioner in person before seeking the procedure - an informed medical diagnosis is an important part of managing chronic pain.
What Is a Nerve Block?
A nerve block is a type of injection therapy which blocks nociceptive (danger) signals from reaching the brain. If used for the right indication, nerve blocks are usually more successful in reducing pain than injecting medication into a vein or into the muscle. Minimal pain and relatively easy recovery mean that you can begin physical therapy and the application of lifestyle modifications sooner, too.
Types of Nerve Block Procedures
Peripheral Nerve Block
In a peripheral nerve block, local anaesthetic is injected near a specific nerve or group of nerves. This inhibits the signals traveling from the area being blocked to the brain, preventing the sensation of pain. The location of the injection will feel numb. Often your interventionalist will combine radiofrequency neuromodulation with injections to increase the length of time you feel relief.
Epidural and Spinal Nerve Blocks
Spinal nerve blocks target a single large nerve at its source – its exit from the spinal cord. This procedure is performed in conditions where a single nerve is irritated, impinged or damaged, and that whole nerve needs to be desensitised.
Spinal nerve blocks are very useful in treatment of conditions such as radiculopathy and neuropathy. The practitioner aims for the root of the nerve and injects a combination of cortisone and local anaesthetic at the part of the nerve responsible for feeling. You pain practitioner may also choose to combine this injection with radiofrequency neuromodulation.
An epidural is an analgesic injected into the space between the spinal cord and its membranous covering, stopping pain and provide partial pain relief. These types of blocks are usually for use in labour or after an accident, rather than as part of chronic pain treatment.
Sympathetic Nerve Block
In a Sympathetic nerve block a pain practitioner makes an injection around the nerve roots (usually along the spine), which are responsible for balancing the sympathetic nervous system, otherwise known as the fight or flight system. There are distinct collections of nerves along the spine responsible for controlling or aggravating chronic pain conditions and their activity can be turned down with radiofrequency neuromodulation. This type of procedure is particularly effective for neuropathic pain, diabetic neuropathy, complex regional pain syndrome, and more.
Lumbar Sympathetic Nerve Block targets the nerves in the lumbar spine supplying the lower limbs for conditions like sciatica or complex regional pain syndrome (CRPS).
A Stellate Ganglion Block treats pain in the arm, shoulder, or face by targeting the sympathetic nerves in the neck. These nerve blocks usually help to improve your functionality (being able to perform day to day activities due to lower pain levels) and are also sometimes used as a diagnostic tool, to help find the source of pain.
Diagnostic vs Therapeutic Nerve Blocks
Diagnostic Nerve Blocks help to pinpoint the source of the pain, blocking signals from specific nerves temporarily. Depending on the type of anaesthetic used, these usually last a few hours.
If you experience some relief from the pain after the injection, it suggests that the targeted nerves are the source of the pain – allowing the team to diagnose more accurately and create a treatment and management plan.
Therapeutic nerve blocks provide pain relief and reduce inflammation in chronic and acute pain conditions.
When and Why Are Nerve Blocks Used?
Nerve blocks have proven effective in treating chronic pain conditions such as back, neck or hip pain. They can also be used for complex pain conditions that are mediated by other systems like the sympathetic nervous system. In acute cases they’re also used for pain relief during labour and after some surgeries and small procedures.
What to Expect During the Procedure
Preparation
Pain procedures are same-day procedure, so only need a small amount of preparation. You’d need to stop eating the night before and arrive at the clinic the morning of the procedure, wearing comfortable clothing. Once there, you’ll be checked in by the administrative team and asked to put on a procedure gown. Bring along a book or a friend – waiting times can vary.
Sedation
Once you have arrived in the procedure room, your interventionalist and anaesthetist will help you get into a comfortable position on the procedure table, and then the anaesthetist will begin the sedation. The aim is for you to drift off and wake up calmly at the end of the procedure with none of the scary tubes and gasses that are normally used in full anaesthesia.
Tools used
Once you are comfortably sedated, the interventionalist finds the site of the nerve they wish to block using an x-ray, ultrasound or fluoroscopy machine (which uses very low dose x-rays and moves around the bed – you won’t be moved during the procedure). All tools are very low risk; they are simple, safe and have a proven track record within the field of pain medicine.
After using these tools to pinpoint the perfect spots, the interventionalist is able to place thin needles with hollow tips very precisely and inject a combination of local anaesthetic and cortisone. If a radiofrequency neuromodulation is also being performed, the same needles are also used to house the probe that delivers radiofrequency pulses to your nerves.
How Long it Takes
Whilst all efforts are taken to ensure that your procedure goes quickly, the procedure may take different lengths of time for different people. Most procedures take less than half an hour but for more complicated procedures patients can expect to take much longer than that. Your team will never rush a procedure.
What Patients Experience During the Procedure
Depending on the sedation that you choose or is offered to you, your experience can vary from no recollection of the procedure, to partaking in conversation with the interventionalist during the procedure. The Pain Collective takes the utmost care to ensure no pain during all procedures and will make sure you are comfortable throughout. Your team is with you every step of the way.
Risks and Side Effects
Before your procedure, make sure to inform the clinician if you:
- Are pregnant or may be pregnant
- don’t feel well
- have an infection, cold or persistent cough
- are diabetic
- have any allergies to any of the medications involved
- are taking any of the following medication: Antibiotics, Aspirin, Warfarin or Clopidogrel or other blood-thinning medication (some of these may need to be stopped some days before).
Your clinician will be sure to check with you about all of these beforehand, too.
Risks of the Procedures
Nerve block procedures are usually quite safe, however there are a few minor risks that are associated with the use of needles and anaesthetic, as with any other procedure. These can be infection, damage to some small veins or bruising or bleeding around the injection site.
A few days of discomfort and facial flushing are sometimes experienced, and some women may find that their menstrual cycle is altered slightly due to the use of low dose steroids. Other side effects can include delayed stomach emptying, difficulty swallowing, and droopy eyelids.
In rare cases, nerve damage may occur, or an adverse event with the possibility of severe allergic reaction. The injection may raise your glucose levels if you’re diabetic, so levels should be monitored closely for a month afterwards. In intercostal or suprascapular nerve blocks, there is a small risk of Pneumothorax (puncture of the lung).
Make sure to discuss any concerns with your clinician.
Recovery and Aftercare
Recovery time after a pain procedure will always differ from person to person.
Make sure to take it easy for the rest of the day after your procedure – avoid exercise and heavy lifting. We also recommend NO operating of heavy machinery including driving a motor vehicle.
Recovery time is usually dependent on how stiff you may feel following your procedure but since there is no time needed for stitches to heal you will be safe to move around gently the following day, when your sedation has completely worn off. In fact, going for a walk the day after your procedure can speed up your recovery time.
Is a Nerve Block Right for You?
A nerve block procedure can be a good option for managing pain, especially when other treatments haven't been effective. However, they are not suitable for everyone, and it's important to discuss the risks and benefits with your doctor to determine if they're right for you.
There are instances where a nerve block may not be the appropriate treatment of choice for chronic pain; especially if your pain is not localised to a single nerve or group of nerves, or if there is no nociceptive trigger.
Your pain practitioner will always provide you with a carefully made diagnosis, and if a pain procedure is not indicated for your chronic pain your practitioner will work with you to explore all other treatment options.
Final Thoughts
Chronic pain is no longer taboo. The medical community have come a long way in understanding chronic pain and what causes it. If your pain practitioner finds a nociceptive trigger that can be targeted with a nerve block, they’ll guide you through the process.
Chronic pain Is multifactorial and thus no single treatment option exists to cure it. Although pain procedures are effective, the Pain Collective only recommends them when combined with lifestyle change and rehabilitation.