MEDIAL BRANCH BLOCKS

1. What is a facet joint? There are many causes of back pain. They include bulging and herniated discs, spinal stenosis, and sacroiliac joint disease. Inflammation of the facet joints is one of the causes of this type of pain. The spine is composed of bony vertebral bodies, which are stacked on top of each other and separated by a disc. A facet joint connects the upper part of one vertebral body to the lower part of another vertebral body in the spine. Occasionally, this joint can become irritated or inflamed causing pain. 2. What is medial branch? Each facet joint gets its sensation from two nerves around the spine. The name of the nerves that supply the sensation to the joint is the medial branch. In order to stop the sensation to a single joint, each of these two nerves need to be anesthetized with local anesthesia.

3. How do I know if the facet joint is the cause of my pain? Only your doctor or pain specialist can tell. The symptoms of a problem with the facet joint include back pain and pain radiating down the leg as well as pain with twisting or bending of the back. These symptoms are very similar to those that occur with spinal stenosis, bulging or herniated discs and sciatica. Your doctor will examine you to determine whether the cause of your pain may be related to the facet joints. He may order a CAT scan or MRI to look more closely at these joints. Often he may suggest a simple diagnostic procedure, which involves placing a local anesthetic such as novocaine in the joint or near the medial branches. If after the injection the pain disappears or lessens then the facet joint may be a cause of your pain.

4. How is Facet Joint pain treated?
Initially, conservative treatment is prescribed. This consists of rest, anti-inflammatory medications and physical therapy. If this is not successful, an injection into the joint or medial branch nerves may help. A pain specialist does this, usually an anesthesiologist, using X-Ray guidance.

5. How is the injection done?
First, you will have a consultation with the pain specialist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. If you are diabetic, the doctor will need to know that as this injection may cause a rise in blood sugar several days after the procedure. You must have someone with you after the procedure to drive you home. The injection is usually quick, only several minutes for each side. The skin is numbed with a small amount of local anesthetic (lidocaine). Once the numbing medication is given, there is little or no pain during the injection. Although sedation is usually not necessary, a small amount of sedation can be given for an anxious patient. The needle is placed in the joint under X-ray and the medication is then given. You will have a brief recovery and will then be discharged home with your driver.

6. What should I expect after the procedure?
Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain will return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The medication itself may take several days to work. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.

7. How many injections do I need?
You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, a second may then be given. Usually no more than three injections are given within 6 months. If the injections do not relieve your pain, then the source of the discomfort may not be the facet joint. There are several problems that cause similar symptoms including bulging or herniated discs, spinal stenosis and disease in the sacroiliac joint of the spine.

8. What are the risks of the injection?
Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site. There are some side effects that can occur from the medication that is injected. This includes a rise in blood sugar, weight gain and water retention. These effects are minimized by using low doses of the medication and limiting the number of injections to three within 6 months.

9. Should I get the injection?
That decision can only be made after you see the pain specialist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a problem in the Sacroiliac joint is the likely source of your problem and if you are a candidate for the procedure.