Is Your Back Pain Becoming Unbearable?

Navigating back pain can be a challenging endeavor. Sometimes, the pain can prevent even the simplest activities. Every day, doctors see thousands of patients with chronic back pain. These patients often start with conservative treatment like physical therapy, massage, and bracing. However, if these fail, doctors may suggest a medial branch block (MBB), which can happen with or without steroids.

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Common reasons for back pain

The spine contains several facet joints that help with stability. Close to these joints are the medial nerves which send pain signals to the brain. With osteoarthritis, the facet joints' wear and tear can put pressure on nearby nerves. The joints can also develop bone spurs that irritate nerves, causing lower back pain, stiffness, sciatica, and other conditions. A medial branch block is a non-invasive procedure that can help doctors diagnose and treat back pain.

The MBB process

An MBB starts with a visit to a doctor, pain specialist, or radiologist. During the procedure, the patient will lie down on an operating table. The doctor will clean and mark the injection site and provide a topical numbing solution. A guided x-ray technique called fluoroscopy is used to locate the facet joints. The needle that contains the medication is then placed near the nerves and joints to administer anesthesia. Sometimes, the doctor will treat more than one facet joint. MBB takes less than an hour, and the patient can leave on the same day. Side effects can include mild swelling and discomfort for 24-48 hours, but most people can resume normal activities shortly after.

With or without steroids?

A medial branch block can be therapeutic or diagnostic. For some patients, the pain will go away long-term, but for others, the pain returns soon after the procedure. In some cases, adding a steroid to the treatment regimen can produce better results and extended comfort. On average, patients should get 1-2 months of pain relief from a MBB. Some patients choose to have multiple branch blocks over the year. The doctor can suggest long-term treatment if the MBB confirms the patient has a facet joint problem.

What's next?

Although MBB can provide relief for many patients, the procedure doesn’t always work long-term. Radiofrequency ablation (RFA) is a similar non-surgical procedure that can be tried after MBB. However, instead of administering medication, a thin electrode burns off the nerve ends, interrupting the nerve's communication with the brain. RFA can provide long-lasting relief for over a year. Some patients are also good candidates for endoscopic rhizotomy. This minimally invasive procedure goes further, using a camera to allow the surgeon to get closer to the nerves. Radiofrequency waves can then sever the nerves directly affected by the facet joint. This surgical procedure may provide long-term relief over 5 years.

Time to book a block?

Medial branch block without steroids can provide some relief, but this will be short-lived. The main reason for a MBB without steroids is to diagnose the underlying condition. Adding steroids offers long-term relief for at least 2 months and may be a good option. However, MBB can usually only be done a few times per year, so some patients may need more advanced treatment. Talking to a healthcare provider about the specific condition and treatment options available is an excellent place to start.

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