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Pain and Debilitating Conditions

Nerve Root/Medial Branch Blocks/Radiofrequency Rhizotomy

Selective nerve root block injections refer to medications injected into the nerve root itself or, in the case of medial branch blocks, the nerves that go to a joint. Radiofrequency rhizotomy ablation uses highly localized heat to destroy nerves in joints. The goal of all three interventional pain management treatment services is to block pain signals from the spine to the brain in order to provide pain relief. Selective nerve root and medial branch block injections and radiofrequency rhizotomy are just a few examples of interventional pain treatments available at our pain management center. For our pain management physicians, interventional means that patients have access to and are provided with the best possible care from professionals in a variety of therapeutic disciplines. It is through a team approach that we help patients find relief from their acute or chronic pain conditions to live a better quality of life.

During a Nerve Root Block, Medial Branch Block, or Radiofrequency Rhizotomy Procedure
Patients undergoing selective nerve root or medial branch block procedures will be asked to lie on their side or stomach. In some cases, an intravenous (IV) line is started to administer medications that will relax the patient. A local anesthetic will be given to numb the area and then several drops of a contrast solution will be injected so that the physician will be able to confirm the correct location of the medication under x-ray fluoroscopy. Upon confirmation, medication is then injected into the nerve root or nerves that go to a joint to block pain signals from reaching the brain. From start to finish, either procedure takes about 30 minutes to one hour. If patients experience virtually no pain relief, then another level of the spine may be treated to determine the source of pain.

Patients undergoing a radiofrequency rhizotomy procedure will remain awake to provide important feedback to the attending surgeon. A thin needle electrode will be placed adjacent to the painful joint. The surgeon will use x-ray to guide the needle and apply sensory and motor stimulations with low voltage electricity to verify proper needle placement. The latter will cause the affected muscles to rhythmically contract. An anesthetic will be used to put the nerve to sleep and then the surgeon will apply heat to the nerve via the electrode for approximately 60-90 seconds. The heat is designed to create a lesion, causing the nerve to become cauterized or burnt, which in turn removes the pain signals.

Possible side effects from a selective nerve root or medial branch block procedure may include facial flushing, occasional low-grade fevers, hiccups, insomnia, headaches, water retention, increased appetite, increased heart rate, and abdominal cramping or bloating. Those that experience such side effects typically find that they disappear within 1-3 days after the injection. Similarly, patients who pursue radiofrequency rhizotomy as treatment may experience an increase in symptoms for 5-7 days after the procedure due to the trauma to the nerve. However, pain relief for both acute and chronic pain conditions should be apparent within 2-4 weeks.