Nerve Blocks For Pain

A large branch of pain management consists of nerve blocks. these are injections that disrupt pain signals coming from a group, or ganglion, of nerves. When nerves are irritated during movement or compressed from a chronic medical condition, they may malfunction. Abnormal nerve function can cause pain in where they are located, as well in distant areas of the body. Local or radiating pain may also be accompanied by other symptoms that make daily life difficult. Nerve blocks, though they do not correct causal issues, will alleviate pain to allow for comfortable function as well as aid in the effectiveness of other types of treatment, and help in diagnosing specific medical conditions.

There are multiple types of nerve blocks that treat specific conditions of ganglions in different areas of the body.

SELECTIVE NERVE ROOT BLOCK (CERVICAL/ THORACIC/ LUMBAR)

Nerve roots exist on each side of every vertebra in the spine. It is from these roots that branches of nerves originate, traveling throughout the back and to the extremities. For this reason, compression of a nerve root can cause pain to radiate to other areas. A selective nerve root block is an injection that targets a single nerve root. The first injection is aimed at one root with only local anesthetic. If it relieves pain for a brief period, a physician may safely determine that the targeted nerve root is the cause of the problem. After this diagnostic injection, a selective nerve root can serve as regular therapy. A corticosteroid, a powerful anti-inflammatory, is injected into the nerve root, numbing it for months at a time. A selective nerve root block may be preformed on the nerve roots of the cervical, thoracic, or lumbar spine.

OCCIPITAL NERVE BLOCK

An Occipital Nerve Block is an injection into the base of the skull that is intended to diagnose the cause of and then relieve chronic headaches and migraine pain. The greater and lesser occipital nerves are located in the back of the head, just above the neck. If these nerves become irritated, as could happen after chronic neck pain and tension, they will inflame, causing considerable swelling and head pain. The pain may replicate a migraine, but the nerves will not respond to any medications.

During this procedure, the needle will enter the back of the scalp and reach the occipital nerves, where corticosteroid will be injected to reduce long term swelling. If headaches are relieved after the first occipital nerve block injection, it can be determined that the occipital nerves are indeed the source of pain. The injection may then be used as a regular therapy once every few months, as needed.

PERIPHERAL NERVE BLOCK

A peripheral nerve block numbs nerves that are compessed, or under constant pressure that causes painful swelling. Several ganglions are treated by peripheral nerve blocks. Types of peripheral blocks include:

  • Pudendal Nerve Block– Entrapment or injury to the pudendal nerve causes pain in the anal region along with the scrotum for men and vulva for women. Pain is especially felt upon sitting.
  • Ilioinguinal Nerve Block– Entrapment or injury to the ilioiguinal nerve causes pain in the upper inner thigh and some of the pubic area.
  • Genitofemoral Nerve Block– Entrapment or injury to the genitofemoral nerve causes pain of the inner thigh, labia majora for women and scrotum for men.
  • Piriformis/ Deep Gluteal Nerve Block of Sciatic Nerve– The sciatic nerve runs along the piriformis and gluteus muscle. Inflammation of the sciatic nerve will cause tightness and pain in this muscle, resulting in deep painful sensations in the buttocks or gluteus area.

DIAGNOSIS

Since X rays and MRIs usually cannot determine the condition of nerves, a special type of nerve testing is done to locate abnormalities in the nervous system. EMG and NCS tests map the electric pulses of nerves and turn the readings into graphs. A physician is able to detect abnormalities in the graphs, and determine where the problematic nerves are. The first injection usually serves as a diagnostic test as well. If pain is relieved through an injection of a small dose of local anesthetic, then it can be determined that the targeted nerves are the source of pain. A more powerful dosage of corticosteroid or radio frequency can then be used as a long term therapy.

PREPARING FOR THE PROCEDURE

  • Arrange for a ride home after the procedure.
  • Plan to rest for the entire day.
  • Notify the physician of any current medications.

THE PROCEDURE

Injections are usually administered with the patient lying down. After the skin is sterilized, a thin needle is inserted into the marked area with a mixture of medications. A local anesthetic is used to numb the area to the pain of the needle piercing the deep tissues. A corticosteroid is injected to reduce inflammation for a longer period of time. The local anesthetic will provide immediate pain relief, but soreness and pain may return within the next two days. This irritation will wear off, and the full effects will be felt after the corticosteroid has had a few days to become fully active. It is usually fine to go to work the following day, as some soreness should be the only side effect.
The patient will be monitored for 15 minutes following the procedure. It is important to give the physician feedback so future therapeutic injections may be planned for properly.

RESULTS

The time for which the nerve block will relieve symptoms completely depends on how inflamed the nerves are and how the individual patient reacts to the medication. If underlying medical conditions do not cause severe inflammation, the nerve block should be effective for at least six months. Generally, a patient is not treated more than three times in six months, due to the shrinking effects a corticosteroid may have on soft tissue when in direct contact. The nerve block will usually only treat the painful symptoms of a chronic condition.

SIDE EFFECTS

Uncommon risks are associated with nerve blocks. As with any deep tissue injection, soreness and bleeding may occur. Allergic reaction are very rare. The patient will commonly feel soren after the injection, but this usually lasts about 2-3 days at most. The corticosteroid may increase blood sugar in some patients.

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