Therapeutic Pain Blocks
The relentless pain of an injury or the aftermath of surgery can be overwhelming. If standard pain-relieving medicines don't work, your health care provider may suggest injecting pain-relieving medicine into the site of the affected nerve. This injection will block the pain signals the nerve would otherwise send to your brain. If your brain doesn't receive this message of alarm, you won't feel the pain you would normally feel. Your health care provider might also include a steroid in this injection. This will help to control swelling and inflammation around the nerve. This approach can help with short-term pain, like recovery from surgery or trauma, or acute pain from damage to the soft organs, or viscera. It is also commonly used along with other treatments for chronic joint and nerve pain.
How a therapeutic pain block is done
Your health care provider might want to do 1 or 2 nerve block tests to find out the best place to inject medicine to control pain. This approach means the medical team will inject the pain-relieving medicine, or anesthetic, close to the nerve most likely to carry pain signals from the injured area to the brain. If that works to relieve your pain, then that is where the therapeutic block will be applied. If your pain is not eased, he or she may try another location.
Types of therapeutic pain blocks
Click to Enlarge: Example of epidural insertion
These are common types of therapeutic blocks:
Epidural. Many women get an epidural to ease the pain of labor and childbirth. If you are feeling severe pain in your neck, back, or leg because of inflamed or "pinched" spinal nerves, your health care provider may inject a steroid into the epidural space — the space near the spinal canal — in the region of the irritated nerve. Often, the steroid is used along with an anesthetic. The injection is typically guided by moving X-ray images. A steroid, like cortisone, helps reduce inflammation in the area.
Facet joint. Injections of a steroid with local anesthetic into the facet joints in the spinal bones, or vertebrae, can help treat back pain resulting from arthritis or injury. Pain in the neck, middle back, lower back, buttocks, or upper legs can be controlled in this way.
Sacroiliac joint. Injecting a steroid with local anesthetic medicine into the sacroiliac joint, the area between 2 of the pelvic bones in the lower back, can block pain in the buttocks, upper leg, and lower back.
Suprascapular nerve block. This type of block can be useful for chronic pain involving the shoulder that does not respond to injections directly into arthritic joints. It can also be used to block shoulder pain that is severe enough to interfere with needed physical therapy.
Occipital nerve block. Injection of a steroid with local anesthetic into the occipital nerves in the back of the head can help relieve pain from chronic headaches and types of neuralgia.
Nerve blocks can also be used to block pain to a specific area, like the wrist, during surgery for local or regional anesthesia, or after surgery for pain control. Nerve blocks work most effectively if your pain is related to a single nerve or a small group of nerves. Other types of pain might not be improved with this approach.
Done by a trained, qualified professional, nerve blocks are considered safe. Like all procedures though, nerve blocks do have some risks associated with them:
Damage to the nerve, causing loss or sensation of loss of strength in the area of the nerve, or more severe pain
Itching, swelling, or pain at the injection site
Raised blood sugar levels, from steroid injections
Rarely, muscle weakness or paralysis if damage happens to the spinal cord or a major nerve
Limitations of therapeutic nerve blocks
Although they can bring longed-for relief, therapeutic nerve blocks are not a cure for pain. Their effects may only last for a limited period of time. They are often part of a full program that may include oral medicines, exercise and stretching to help you recover from your injury.
If you are recovering from surgery, the block should last through the initial recovery stages. In other situations, make sure you understand when to call your health care provider about breakthrough pain.
- Cyriac, James, MD
- Moloney Johns, Amanda, PA-C, MPAS, BBA