Procedure Information

First understanding the anatomy of your back can help you learn how these blocks work. To start, your spine consists of vertebrae cushioned by intervertebral discs that are further stabilized by facet joints. These joints allow your spine to twist and flex safely. Running through and innervating each facet joint is the medial branch of the dorsal ramus nerve - the first branching nerve root in the spine.

Over time, and sometimes because of injury or a chronic pain condition, facet joints can become irritated and inflamed. This sends pain signals from the medial nerve to your brain.

A medial branch block reduces inflammation and irritation in the facet joints of the spine, blocking these pain signals. A medial branch block placed directly next to the medial nerve may provide relief when other facet joint injections (into the joint itself) have been unsuccessful.

Medial branch blocks may also be used as a diagnostic tool. For example, patients who find relief from a medial branch block can opt for radiofrequency ablation, a more long-term pain treatment

What conditions can a medial branch block help with?
Medial branch blocks are often useful as a diagnostic tool. If your pain disappears with the injection, then it is clear that your pain originates from the joint.

This minimally-invasive procedure may provide profound pain relief where other conservative treatments have failed and can also help you avoid more interventional surgery. This is what you should know about this procedure, its benefits, and more.

What are epidural steroid injections?
With epidural steroid injections, doctors use an injected pain reliever and an anti-inflammatory medication to reduce pain signals to your brain and relieve inflammation that affects the nerves of your spine.

A common characteristic among the syndromes treated with epidural steroid injections is a pain described as "radicular pain." The word radicular means "root" and typically refers to an irritated nerve root (radiculitis) or weakness of an affected nerve root (radiculopathy).

Radicular pain is pain that radiates from the spine down an irritated spinal nerve root. Irritation of this spinal nerve in your lower back, called lumbar radiculopathy, can cause pain that typically travels down a leg. Likewise, cervical radiculopathy describes pain that travels from neck nerves down an arm.

Epidural injections can help treat nerve compression and damage in your neck (cervical spine), as well as the low back (lumbar spine). They're best for moderate to short-term relief of pain. A major benefit of these types of injections, however, is that they allow you to undergo other pain relieving therapies.

Physical therapy, for example, may be too painful to do when you're suffering from chronic pain. An epidural steroid injection manages your pain while you undergo physical therapy to treat the underlying cause of your pain.They can also provide rapid pain relief so that patients can resume their normal daily activities. This can include physical therapy and other treatments of underlying pain conditions to support healing.

Radiofrequency ablation minimally-invasive procedure that can help patients with chronic pain to avoid surgeries and long recovery times, that was first used in 1931 to treat a patient with trigeminal neuralgia and is now used to effectively treat a variety of chronic pain conditions.

Often used in conjunction with a medial branch block to identify the exact source of nerve pain, radiofrequency ablation (RFA) uses specialized electrodes to disrupt nerve conduction. A probe is inserted through a needle, and controlled delivery of heat is placed along the nerve sending pain signals. This pain relief technique can help with Back pain, Neck pain, Muscle pain, and Multiple other pain syndromes.

How does radiofrequency ablation work?
The individual vertebrae (bones of the spine) provide a flexible support structure while also protecting the spinal cord. The facet joints of the spine are a moveable connection that links one vertebra to another. Facets are innervated by the medial branch nerve, which provides sensation to the joint. Medial branch nerves are small nerve branches that communicate pain from the facet joints to the brain.

The complex structure of the vertebrae and its intertwining with the nerves of the spinal cord means that any damage, injury, or condition that affects the spine has the potential to affect the nerves. Radiofrequency ablation starts with a medial branch block that locates the exact nerve affected so that pain signals can be blocked.

Our muscles and organs are completely encased in a thin web of connective tissue called fascia. When the fascia becomes tight or constricted, it can cause pain in the immediate area, but it can also cause referred pain in another area as the body compensates for its restricted movement. Points of tightness, tenderness, or discomfort in a specific muscle or area of the fascia may affect movement, normal function, or the quality of life of people affected by them.

A myfascial injection injects medication directly into those tight areas within muscles or fascia that are causing pain. These targeted areas for injection are known as trigger points. In some cases, trigger points may be felt under the skin as a knot or nodule. Knots may react with muscle twitches or pain when pressed on with a finger.

The most common medications injected into these points to relieve pain are the local anesthetics lidocaine or procaine. These injections are an effective treatment for pain or discomfort emanating from a trigger point.

What conditions can myofascial injections help with?
One of the most common conditions helped by a myofascial injections is myofascial pain syndrome. When tightened bands of muscle tissue create abnormal contractions and intensify or spread over time to form small, localized areas within the muscle, these trigger points may indicate myofascial pain syndrome.

Myofascial pain syndrome can contribute to other musculoskeletal disorders such as rotator cuff disease (a condition affecting the upper arm and shoulder) by increasing the strain or pressure on a muscle or muscle group.

The formation of trigger points may also be associated with a range of factors and other conditions. These include:
  • Abrupt overload or strain on the affected muscle(s)
  • Arthritis
  • Decreases in the temperature of the affected muscle(s)
  • Emotional distress
  • Fibromyalgia
  • Gall bladder diseases
  • Lumbrosacral radiculopathy (nerve damage in the back) leading to excessive tension in back muscles
  • Muscular fatigue
  • Muscular trauma

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