© Therapeutic Pain Management Medical Clinic 2016 - Site created by Dr. Dhruva 1335 Buenaventura Blvd, Ste 100, Redding, CA 96001. T: (530) 247-7246; (530) 24-7-P-A-I-N.   F: (530) 245-0849   email: mail@TPMclinic.com
Therapeutic Pain Management Medical Clinic (TPM) Improving Quality of Life
Facet Diagnostic Medial Branch Blocks FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   Medical   Branch   Blocks.   It   is   one   of   the   common   procedures   performed   in   this   pain   clinic.     The following material is given as general information only, and is not to be considered as medical advice or consultation. What is a Medial Branch? Facet   Joints   are   innervated   or   “supplied”   by   nerves   called   “medial   branches”.      These   nerves   carry   the   pain   signals   to   the   spinal   cord   and   the   signals   eventually reach the brain, where the pain is noticed. What is the purpose of it? If   the   nerves   are   “blocked”   or   “numbed”,   they   will   not   be   able   to   carry   pain   sensation   to   the   spinal   cord.      It   is   like   temporarily   cutting   off   “wires”.      Therefore,   if   the pain   is   due   to   facet   joint   arthritis,   you   should   have   relief   from   pain   and   stiffness.   Once   it   is   determined   that   the   pain   is   indeed   due   to   facet   joint   disease,   we   can use   a   procedure   called   “Radio-Frequency   Lesioning”   and   prevent   the   conduction   of   pain   information   for   several   weeks   to   months.   So,   in   a   way,   medial   branch block is a temporary and diagnostic procedure. How long does the injection take? The actual injection takes only a few minutes.  More nerves to be blocked, more time it takes. What is actually injected? The injection consists of a local anesthetic (like lidocaine or bupivacaine).   Will the injection hurt? The   procedure   involves   inserting   a   needle   through   skin   and   deeper   tissues   (like   a   “tetanus   shot”).      Therefore,   there   is   some   discomfort   involved.      However,   we numb   the   skin   and   deeper   tissues   with   a   local   anesthetic   using   a   very   thin   needle   before   inserting   the   needle   into   the   joint.      Most   patients   also   receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. Will I be “put out” for this procedure? No.      This   procedure   is   done   under   local   anesthesia.      A   few   patients   also   receive   intravenous   sedation,   which   makes   the   procedure   easier   to   tolerate.      The   amount of sedation given generally depends upon the patient’s tolerance. How is the injection performed? It   is   done   either   with   the   patient   lying   on   the   stomach   for   the   upper   and   low   back   pain,   or   for   the   cervical   (neck   area)   injections   –   in   sitting   position   or   lying   on   the back,   under   x-ray   control.   The   patients   are   monitored   with   EKG,   blood   pressure   cuff   and   blood   oxygen-monitoring   device.      The   skin   in   the   back   is   cleaned   with antiseptic solution and then the injection is carried out. What should I expect after the injection? Immediately   after   the   injection,   you   may   feel   that   your   pain   may   be   gone   or   quite   less.      This   is   due   to   the   local   anesthetic   injected.      This   may   last   only   for   a   few hours.      Your   pain   will   return   and   you   may   have   a   “sore   back   or   neck”   for   a   day   or   two.      This   is   due   to   the   mechanical   process   of   needle   insertion.      It   is   very important   for   you   to   keep   a   track   of   your   pain   and   stiffness   for   the   next   4   to   12   hours   following   injections.      Your   response   to   the   injections   will   determine   if   the facets are the cause of your pain or not.   What should I do after the procedure? You   should   have   a   ride   home.      We   advise   the   patients   to   stay   active   after   the   procedure.      You   may   want   to   apply   ice   to   the   affected   area.      Perform   your   usual activities as tolerated. Can I go to work to work the next day? Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back. How long does the effect of the medication last? The   immediate   effect   is   from   the   local   anesthetic   injected.      Depending   upon   the   medication   injected,   it   can   last   from   2   hours   to   8   hours.      Of   course,   if   the   facet joints are not the source of your pain, you may not have much relief. How many injections do I need to have? Usually   one   session   is   enough   to   determine   if   the   facet   joints   are   the   most   likely   source   of   your   pain   or   not.      However,   the   “placebo   response”   can   be   as   high   as 30   to   40   %   and   some   patients   may   be   recommended   to   have   repeated   diagnostic   injections.      Typically,   Medicare   and   Blue   Shield   covered   patients   need   a   second session.In addition, “False Positive” responses can occur. Will the procedure help me? If   the   pain   is   originating   mostly   from   the   facet   joints,   you   should   benefit   from   this   procedure   on   a   temporary   basis.      Some   do   get   a   “placebo   response”   and   others may   get   a   “False-Positive”   response.      Please   remember   that   these   are   diagnostic   injections   only   and   last   only   for   a   few   hours.      These   are   done   to   determine   if   the pain   is   coming   from   the   facet   joints   or   not,   and   if   the   pain   is   coming   from   the   facet   joints,   we   will   recommend   “Radio-Frequency   Lesioning”   –   which   will   “numb” the same nerves for many weeks to months. What are the risks and side effects? Generally   speaking,   this   procedure   is   safe.      However,   with   any   procedure   there   are   risks,   side   effects,   and   possibility   of   complications.      The   most   common   side effect   is   pain   –   which   is   temporary.      The   other   risks   involve,   infection,   bleeding,   worsening   of   symptoms,   spinal   block,   epidural   block   etc.      Fortunately,   the   serious side effects and complications are uncommon. Who should not have this injection? If   you   are   allergic   to   any   of   the   medications   to   be   injected,   if   you   are   on   a   blood   thinning   medication   (e.g.   Plavix,   Coumadin®),   or   if   you   have   an   active   infection going on, you should not have the injection. What is a positive response? A relief of 75% to 80% lasting for a few hours immediately after the procedure is considered a positive response.
© Therapeutic Pain Management Medical Clinic 2016 Web designed and  created by Dr. Dhruva
Therapeutic Pain Management Medical Clinic Improving Quality of Life
  Facet Diagnostic Medial Branch Blocks FAQs The   following   Frequently   Asked   Questions   and   the   answers   are   for   the   Medical Branch   Blocks.   It   is   one   of   the   common   procedures   performed   in   this   pain   clinic.     The    following    material    is    given    as    general    information    only,    and    is    not    to    be considered as medical advice or consultation. What is a Medial Branch? Facet    Joints    are    innervated    or    “supplied”    by    nerves    called    “medial    branches”.      These   nerves   carry   the   pain   signals   to   the   spinal   cord   and   the   signals   eventually reach the brain, where the pain is noticed. What is the purpose of it? If    the    nerves    are    “blocked”    or    “numbed”,    they    will    not    be    able    to    carry    pain sensation   to   the   spinal   cord.      It   is   like   temporarily   cutting   off   “wires”.      Therefore,   if the    pain    is    due    to    facet    joint    arthritis,    you    should    have    relief    from    pain    and stiffness.   Once   it   is   determined   that   the   pain   is   indeed   due   to   facet   joint   disease, we    can    use    a    procedure    called    “Radio-Frequency    Lesioning”    and    prevent    the conduction   of   pain   information   for   several   weeks   to   months.   So,   in   a   way,   medial branch block is a temporary and diagnostic procedure. How long does the injection take? The   actual   injection   takes   only   a   few   minutes.      More   nerves   to   be   blocked,   more time it takes. What is actually injected? The injection consists of a local anesthetic (like lidocaine or bupivacaine).   Will the injection hurt? The   procedure   involves   inserting   a   needle   through   skin   and   deeper   tissues   (like   a “tetanus    shot”).        Therefore,    there    is    some    discomfort    involved.        However,    we numb   the   skin   and   deeper   tissues   with   a   local   anesthetic   using   a   very   thin   needle before   inserting   the   needle   into   the   joint.      Most   patients   also   receive   intravenous sedation and analgesia, which makes the procedure easy to tolerate. Will I be “put out” for this procedure? No.      This   procedure   is   done   under   local   anesthesia.      A   few   patients   also   receive intravenous   sedation,   which   makes   the   procedure   easier   to   tolerate.      The   amount of sedation given generally depends upon the patient’s tolerance. How is the injection performed? It   is   done   either   with   the   patient   lying   on   the   stomach   for   the   upper   and   low   back pain,   or   for   the   cervical   (neck   area)   injections   –   in   sitting   position   or   lying   on   the back,   under   x-ray   control.   The   patients   are   monitored   with   EKG,   blood   pressure cuff   and   blood   oxygen-monitoring   device.      The   skin   in   the   back   is   cleaned   with antiseptic solution and then the injection is carried out. What should I expect after the injection? Immediately   after   the   injection,   you   may   feel   that   your   pain   may   be   gone   or   quite less.      This   is   due   to   the   local   anesthetic   injected.      This   may   last   only   for   a   few hours.      Your   pain   will   return   and   you   may   have   a   “sore   back   or   neck”   for   a   day   or two.        This    is    due    to    the    mechanical    process    of    needle    insertion.        It    is    very important   for   you   to   keep   a   track   of   your   pain   and   stiffness   for   the   next   4   to   12 hours   following   injections.      Your   response   to   the   injections   will   determine   if   the facets are the cause of your pain or not.   What should I do after the procedure? You   should   have   a   ride   home.      We   advise   the   patients   to   stay   active   after   the procedure.      You   may   want   to   apply   ice   to   the   affected   area.      Perform   your   usual activities as tolerated. Can I go to work to work the next day? Unless   there   are   complications,   you   should   be   able   to   return   to   your   work   the next day. The most common thing you may feel is sore back. How long does the effect of the medication last? The   immediate   effect   is   from   the   local   anesthetic   injected.      Depending   upon   the medication   injected,   it   can   last   from   2   hours   to   8   hours.      Of   course,   if   the   facet joints are not the source of your pain, you may not have much relief. How many injections do I need to have? Usually   one   session   is   enough   to   determine   if   the   facet   joints   are   the   most   likely source   of   your   pain   or   not.      However,   the   “placebo   response”   can   be   as   high   as   30 to   40   %   and   some   patients   may   be   recommended   to   have   repeated   diagnostic injections.      Typically,   Medicare   and   Blue   Shield   covered   patients   need   a   second session.In addition, “False Positive” responses can occur. Will the procedure help me? If   the   pain   is   originating   mostly   from   the   facet   joints,   you   should   benefit   from   this procedure   on   a   temporary   basis.      Some   do   get   a   “placebo   response”   and   others may   get   a   “False-Positive”   response.      Please   remember   that   these   are   diagnostic injections   only   and   last   only   for   a   few   hours.      These   are   done   to   determine   if   the pain   is   coming   from   the   facet   joints   or   not,   and   if   the   pain   is   coming   from   the   facet joints,   we   will   recommend   “Radio-Frequency   Lesioning”   –   which   will   “numb”   the same nerves for many weeks to months. What are the risks and side effects? Generally   speaking,   this   procedure   is   safe.      However,   with   any   procedure   there   are risks,   side   effects,   and   possibility   of   complications.      The   most   common   side   effect is    pain    –    which    is    temporary.        The    other    risks    involve,    infection,    bleeding, worsening   of   symptoms,   spinal   block,   epidural   block   etc.      Fortunately,   the   serious side effects and complications are uncommon. Who should not have this injection? If   you   are   allergic   to   any   of   the   medications   to   be   injected,   if   you   are   on   a   blood thinning   medication   (e.g.   Plavix,   Coumadin®),   or   if   you   have   an   active   infection going on, you should not have the injection. What is a positive response? A   relief   of   75%   to   80%   lasting   for   a   few   hours   immediately   after   the   procedure   is considered a positive response.