Pain Service - Diagnostic Medial Branch Block

If you are on blood thinning medications such as Warfarin, Nicoumalone (Sinthrome), Aspirin, Clopidogrel, Ticlopidine, Apixaban, Rivaroxaban then please contact Booking and Scheduling Department on 0161 778 2233.

What is Medial Branch Block?

A medial branch block is a medical procedure during which pain blocking medicine is injected around a specific facet joint.

The nerve block temporarily prevents the pain signal from being carried by the medial branch nerves that supply the facet joint. Facet joints are small linking joints that connect the bones of the spine, also known as vertebrae. They work in conjunction with the discs and are responsible for controlling the twisting and sideways movements of the whole spine.

Facet joints are located on each side of the spine. Usually they cause no pain at all. However, should they become inflamed or arthritic, often referred to as ‘wear and tear’, they can then become painful.

Medial branch nerves are very small nerves that allow you to feel pain from facet joints. These nerves do not control any muscles or sensation in your arms or legs.

They are located along a bony groove in your low back, neck, and over a bone in your mid-back. These nerves carry the pain signals to your spinal cord and the signals eventually reach your brain, where the pain is noticed.

Why is the injection given and what is the benefit?

Medial branch blocks may be used as a diagnostic test to see whether your pain started from particular facet joints. They are not a cure but may reduce your pain temporarily.

On the day of your injection you will be met by the Pain Consultant who will explain the procedure to you and a written consent form will be completed. There also will be assessment of your pain levels on the day and pain scores.

After the injection, one of two results may be achieved

• The pain does not go away at all. This means that the pain is probably not coming from your facet joints. This can help diagnose the problem and guide future treatment
• The pain goes away for a few hours or days, then comes back and does not improve. This would mean the block was also of diagnostic value

What are the potential side effects and risks?

• There may be some pain and bruising at the needle site which should settle over a few days
• You may feel a little unsteady when you first stand
• The injections may make your pain worse. This should settle within a few weeks
• There is a small risk of infection at the site of the injections
• You may experience some leg weakness or numbness, which should settle within a few hours. If this happens you may have to stay in day surgery until this goes away

The procedure

• The procedure is carried out under x-ray. This allows the doctor to identify the specific area to be treated. It is therefore important that you tell your consultant if there is any possibility that you may be pregnant as x-rays may harm your baby
• You will be asked to lie down on your front. Once you are lying in the correct position your doctor will prepare the area to be treated with an antiseptic solution which may feel cold
• A local anaesthetic is injected at the site of the procedure. This may sting to start with, before your skin goes numb
• It is important that you keep still during the procedure as a special hollow needle will be carefully inserted under x-ray control into the correct position. Local anaesthetic at a higher concentration is injected
• This process may be repeated at different levels on your spine
• A small dressing will be applied to the injection sites. This can be removed after 24 hours. Do not worry if it falls off sooner

What will happen after my injections?

The Pain Consultant may review the procedure and decide what the next step is with you before you are discharged home, or they may telephone you in a couple of weeks time.

You must not drive for 24 hours following your procedure - please arrange for someone to drive you home. It is also strongly recommended that you have someone who can stay at home with you until the following day.

Normal activity should be started as soon as possible. However, you should avoid any strenuous activities for at least one day after the medial branch blocks. You may notice an immediate improvement, but this can be delayed for a few days. Sometimes there may actually be slight increase in pain for 24 to 48 hours.

Will I need a follow-up appointment?

Your Consultant will have made a decision about the next procedure and a future booking will be made.

If the Consultant decides to see you in the clinic instead this will be arranged by the secretary.

It is very important that you inform the doctor or secretary in the pain clinic at least one week before the injection if:

• You are allergic to any medication
• You have an infection near the injection site
• You think you may be pregnant
• You are a diabetic on Insulin
• Caution should be exercised if you have had a recent heart attack or vaccination
• If you have been started on any new blood thinning medication

Contact Details

Fairfield
Day Surgery 0161 778 2503
Pain Secretary 0161 778 3821

Rochdale
Day Surgery 01706 517132/517133
Pain Secretary 01706 517705