Joint Pain

Nerve Blocks for Joint Pain Management

Every person experiences physical pain in different ways and in varying degrees.  The pain could either be acute or chronic, and treatment also comes in a number of ways, like drugs, acupuncture, electrical stimulation, physical therapy, surgery, psychological counseling, behavior modification, and/or nerve blocks.  The latter involves injection of local anesthetic onto or around nerves to momentarily ease the pain.  Nerve blocks are also used as a diagnostic tool to determine the specific source of pain.

There are many different types of nerve blocks, to name a few:

Diagnostic Facet Injection

Since there are several potential sources of back pain, the doctor cannot readily pinpoint the exact cause of the ailment, and so he applies varied techniques, one of which is diagnostic facet injection. It is a procedure that aims to assist doctors in the proper identification, diagnosis and treatment of infirmities in the facet, which is usually caused by the deterioration of the facet joints.  This injection, which is basically a blend of corticosteroid and a local anesthetic, serves to reduce inflammation and a temporary pain reliever that usually lasts for a few days or more than a year so that the patient may be able to perform his normal activities or continue with his physical therapy program.

injection types

Diagnostic facet injection is a minimally invasive procedure that takes around 30 minutes to perform.  After the patient has received a local anesthetic to his skin, another needle is then inserted, under the guidance of a fluoroscope, into the surrounding tissue of the facet joint or into the joint capsule. Once the target is located, an anesthetic is put in.  If the patient experiences pain relief after the injection, the doctor may then conclude that the source of the patient’s back pain is the facet joint.

Stellate Ganglion Block

A stellate ganglion block is an injection of local anaesthetic applied on front part of the neck to ease the pain due to nerve injury, nervous system disorders, and other disease, such as shingles, complex regional pain syndrome, reflex sympathetic dystrophy (RSD), and sympathetic maintained pain. The injection is typically composed of a local anesthetic, such as lidocaine or bupivacaine; although, sometimes, epinephrine is added to extend the effectivity of the injection.  Just like a typical injection, stellate ganglion block takes only a few minutes to perform.  The procedure is begun with patient slightly sitting up or lying on his back while his head is tilted back, exposing more of his neck, since it is where the injection is administered. 

Stellate Ganglion Block injection

The attending nurse will give him an IV medication to make him relax and comfortable even as he is monitored by EKG, with blood pressure monitoring strap on his arm, attached with a monitoring device for blood oxygen, and a temperature sensing probes are put in his thumbs or hands.  Then, the skin next to his ‘voice box’ is applied using antiseptic solution before the actual injection is performed.  As the injection slowly creeps in, the patient also feels shoulder pain.  The temporary after-effects of the injection include, hoarseness of voice, lump in the throat, nasal congestion.  He may also feel warm, and dry.

Sympathetic Nerve Block

Sympathetic nerve block diagnostic test usually used to performed to actually determine the presence of injury to sympathetic nerve chain, also to verify whether it is the actual source of the pain.  It is carried out by injecting an anesthetic around the sympathetic nerves in the lower back to alleviate pain in that area.  If, after the injection, the pain subsides, the doctor may now confirm a diagnosis of sympathetically mediated pain.

The sympathetic nerves, which are part of the autonomic nervous system that runs on the front surface of the spinal column, controls a number of involuntary bodily functions, like the opening and narrowing of blood vessels.

To perform the sympathetic nerve block, the patient is required to lie down on an x-ray table, and initially given a local skin anesthetic in his lumbar area.  With the aid of a fluoroscope, the physician will then insert a needle into the sympathetic plexus of nerves and inject a contrast dye to ensure the target location, and once this is determined, he may now inject an anesthetic medication right into the sympathetic nerves.  The procedure itself takes only about 30 minutes, while the evaluation and recovery period that follow would take a number of hours.  The patient may then experience a warm sensation and redness on his lower extremity.  Once the sympathetic chain is confirmed to have been the source of pain, the doctor may then prescribe oral medication to reduce such type of pain.

Nerve blocks have side effects and risks, though, and it is not for everyone who has pain problem.

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