Nerve Block for Back Pain
Ideally, the best alternative for treating neck and back pain would be a physical therapy program or other treatment that is designed to eliminate the source of back pain. The source of pain may be due to a structural problem in the spine that is either causing spinal instability or pressure on the spinal nerves. Perhaps a stretching and exercise program may stabilize the spine to the point that pressure is taken off the spinal nerves.
In other instances, removing the cause of back pain at its source may be more difficult, due to degenerative changes in the spine that may never fully heal. In pain cases involving one or more spinal nerves, a nerve block for back pain may be the most appropriate treatment.
Facet Injections and Selective Nerve Root Block (SNRB): Pain management techniques such as facet injections and Selective Nerve Root Blocks (SNRBs) may be useful in several ways to the patient. The SNRB may provide patients with immediate pain relief, helping to provide instant comfort. If the SNRB does manage to provide immediate pain relief, that provides a benefit to the patient and it helps doctors to confirm that that was the actual source of the pain signal. Secondary to its diagnostic value, the nerve block for back pain may provide neck pain, back pain, and leg pain relief.
When a nerve root becomes compressed or inflamed, pain may be felt at the site of injury, and at any point along the path of the nerve. This helps explain why patient's neck pain radiates down the arm, and leg pain radiates down the leg. Doctors often may guess which spinal nerve is at the root of the patient's pain based on the descriptions that the patient gives. MRI (Magnetic Resonance Imaging) will often confirm the suspicion of nerve root compression, but in some cases the images do not provide definitive information. If the results of the MRI are not conclusive, than an SNRB injection may help to positively identify the cause of pain. In addition to the SNRB being a key diagnostic tool, it may be an appropriate treatment for a far lateral disc herniation. A far lateral disc herniation is a condition where herniated disc material ruptures outside the spinal canal.
Procedure: This procedure includes injections of Lidocaine (a numbing agent) and a steroid (anti-inflammatory medication). A live X-Ray technique known as Fluoroscopy is used to guide the needle into the intervertebral foramen (the opening in the spine where the nerve root exits). With Fluoroscopy, the doctor can use live video or snapshot images to see the needle in the body as it approaches the foramen. The patient is awake throughout the procedure, and can provide immediate feedback if the injection brings about immediate pain relief. If the pain relief is immediate, it can be inferred that that nerve root is the cause of pain. Following the lidocaine injection, the steroid is introduced into the same area to help reduce inflammation around the nerve root. The inflammation may be significantly reduced from weeks to up to a year - it varies from person to person greatly.
If the SNRB does work, it may be used for up to one time a year. Any usage of steroid into the same area more often than that could cause irreparably damage to the tissue.
Facet Joint Block: Just like the SNRB, the facet joint block procedure may have diagnostic and clinical benefits. This procedure is done when it is supposed that the facet joint itself that is the source of pain.
The facet joints include pared joints in the back of the spine that connect each vertebra to the one above and below it. Each vertebra has four facets, with two projecting upwards and tow projecting downwards. The facets come together and have opposing surfaces of cartilage to prevent wear and tear. There is a surrounding capsule to hold the two opposing facets together. Cartilage damage and twisting injuries may bring about injury to the facet joints.