Exploring Facet Joint and Medial Branch Nerve Blocks Injections for Pain Relief

Exploring Facet Joints and Medial Branch Nerve Blocks Injections for Pain Relief

“I wake up in the morning with a headache, pain and a stiff neck. It hurts to move in all directions by the end of the day. I hear this grinding sound when I turn from side to side…my back keeps me from sleeping at night. Every time I rollover I wake up; I am more tired when I wake up than I was before I laid down... I sleep with a pillow between my knees, but that only helps a little. I’ve tried everything, heat and ice, heat without ice, heat alone, ice alone. I am eating analgesics every few hours. There has got to be a better way. My primary care provider sent me to PT, but I’m in so much pain, I can’t move. I really need some help…”

As you can see, it may not be an easy diagnosis and it may be time to consult a specialist. As a board certified, Interventional Pain Management Specialist, I’ve heard this story from countless patients. It’s the pain that doesn’t radiate much, it's just in one spot aggravated by movement. The most likely culprit is inflammation of the facet joint in your spine. The facet joints are the posterior two joints of the three joint apparatus that make up your spine. 

The big joint in front is where the disc is that joins each vertebra from the neck to the sacrum is the focus of most treatment. However, the facet joints in the back are just as important. A narrowing of the facet joint apparatus is called foraminal stenosis. Foraminal stenosis can cause a direct pressure of the nerves as they leave your spine. Disc hernia can cause this; however, it can also be caused by overgrowth of tissue, bone, or all three. If this occurs, you will have symptoms in your arms, legs or even abdomen. 

Our first step would be a physical examination. If the physical examination matches your story then it’s off to obtain appropriate labs and diagnostic imaging such as x-ray for radiographs. Once your checklist is done, we are ready to review treatment options, but will it be diagnostic facet joint injection or diagnostic medial branch nerve blocks? Typically, they offer similar results. Your insurance carrier will most likely determine which it considers more accurate. In both cases, the effect should last several hours with a reduction of pain score of 70-90%. If that occurs, you may be a candidate for ablation of the medial branch nerves to those facet joints, a procedure called radiofrequency ablation.

Anthony Alexander, MD

What You Need To Know About Facet Joint and Medial Branch Nerve Block Injections

In summary, facet joints connect the posterior portion of each vertebra in your spine together from neck (cervical) to sacrum, allowing you to bend, twist, and move your neck, chest and back. These joints have cartilage and a capsule filled with fluid, which makes movements smooth and painless. If trauma caused by work damaged the facet joints or sports related chronic injury; you may experience neck, posterior chest and lower back pain, which can be severe. The condition is Facet Syndrome, and can be caused by:

• An inflammatory joint condition
• Overuse of the area
• Trauma from an accident or injury

Before beginning facet joint injections, your doctor should:

• Perform a comprehensive examination of your neck, chest and back.
• Record a complete medical history including injuries, medications, and especially neck, chest or back pain symptoms.
• Order diagnostic imaging, including X-rays, CT scans, ultrasound or MRI
• Order lab testing to determine if there are underlying medical issues affecting your neck, chest or lower back.

Facet joint and medical branch nerve block injections are placed precisely, with the use of X-rays to guide the correct placement of the injection. Local anesthetic is injected directly into the joint or the medial branch nerve. These procedures generally take about 15 minutes to complete and can be repeated twice in a six-month period. They are a non-surgical pain relief option that can provide months of pain relief.

Want To Know More?

Visit our library/video resource pages:

https://www.mypmrc.com/root-blocks

https://www.mypmrc.com/nerve-ablations

Ready To Get the Help You Need?

Dr. Anthony Alexander at The Pain Medicine & Rehabilitation Center offers a wide range of pain management services, including facet joint and medial branch nerve block injections. 

• Convenient office locations in Seymour and Jeffersonville, IN 
• Call today to learn more and schedule a consultation (812) 523-3700.