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Interventional Pain Management

Nerve Root / Medial Branch Blocks / Radiofrequency Rhizotomy

Selective nerve root block injections refer to medications injected into the nerve root sleeve itself or, in the case of medial branch blocks, the nerves that supply a joint. Radiofrequency rhizotomy ablation uses highly localized heat to destroy the nerves that are sending pain signals from the facet 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. Our pain management physicians can provide the option of these interventional procedures so that patients are provided with the best possible care and thus, maximizing outcome. Through a holistic approach, we help patients find relief from their acute or chronic pain conditions in order to live a better quality of life.

Nerve Root Block, Medial Branch Block, or Radiofrequency Rhizotomy Procedure
You will be brought to the fluoroscopy suite. Patients undergoing selective nerve root or medial branch block procedures will be asked to lie on their stomach. In most cases, an intravenous (IV) line is started to administer medications that will relax the patient (moderate sedation). Under x-ray fluoroscopy, the target injection area(s) will be localized. A local anesthetic will be given to numb the area and then the spinal needle will be inserted. Contrast will be injected for confirmation. Then, an anesthetic is injected to block the nerves which are transmitting the pain signals. The entire procedure usually takes about 30 minutes to one hour. If patients do not experience significant pain relief, then another spinal level may be injected to help localize the source of pain.

Patients undergoing a radiofrequency rhizotomy procedure will remain awake to provide important feedback during the procedure. A special needle electrode will be placed instead of a spinal needle. X-ray will be used to guide the needle into the target position. Then, sensory and motor stimulations will be used to verify proper needle placement. The latter may 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 special electrode needle for approximately 60-90 seconds. The heat will lesion the nerve that is sending pain signals. This similar procedure is repeated for the remaining targeted levels.

Possible side effects from a selective nerve root or medial branch block procedure may include facial flushing, occasional low-grade fevers, hiccups, insomnia, headaches, injection site pain, increased heart rate, and abdominal cramping. These potential side effects typically disappear within 1-3 days after the injection. For selective nerve root or medial branch block procedure, pain improvement is noted usually within 3 days. For patients who pursue radiofrequency rhizotomy as treatment, you may experience an increase in pain symptoms for up to 5-7 days after the procedure. However, pain relief should be apparent within 2 weeks.