Understanding Nerve Blocks: Diagnosing and Treating Pain

For individuals dealing with chronic pain, can undergoing a nerve block procedure help alleviate and manage symptoms?

Nerve Blocks

A nerve block is a procedure done to interrupt/block pain signals due to nerve dysfunction or injury. They can be used for diagnostic or treatment purposes, and their effects can be short or long-term, depending on the type being used.

• A temporary nerve block may involve the application or injection that stops pain signals from transmitting for a short time.
• For example, in pregnancy, an epidural injection can be used during labor and delivery.
• Permanent nerve blocks involve cutting/severing or removing certain parts of a nerve to stop pain signals.
• These are used in cases with severe injuries or other chronic pain conditions that have not improved with other treatment approaches.

Treatment Usage

When healthcare providers diagnose a chronic pain condition caused by nerve injury or dysfunction, they may use a nerve block to locate the area generating pain signals. They may perform electromyography and/or a nerve conduction velocity/NCV test to pinpoint the cause of chronic nerve pain. Nerve blocks can also treat chronic neuropathic pain, such as pain caused by nerve damage or compression. Nerve blocks are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis. (Johns Hopkins Medicine. 2024)

Types

Three types include:

• Local
• Neurolytic
• Surgical

All three can be used for conditions that cause chronic pain. However, neurolytic and surgical blocks are permanent and are only used for severe pain that has worsened with other treatments unable to provide relief.

Temporary Blocks

• A local block is done by injecting or applying local anesthetics, like lidocaine, to a certain area.
• An epidural is a local nerve block that injects steroids or analgesics into an area around the spinal cord.
• These are common during pregnancy, labor, and delivery.
• Epidurals can also be used to treat chronic neck or back pain due to a compressed spinal nerve.
• Local blocks are usually temporary, but in a treatment plan, they can be repeated over time to manage chronic pain from conditions like arthritis, sciatica, and migraines. (NYU Langone Health. 2023)

Permanent Blocks

• A neurolytic block uses alcohol, phenol, or thermal agents to treat chronic nerve pain. (National Institute of Neurological Disorders and Stroke. 2023) These procedures damage certain areas of the nerve pathway on purpose so that pain signals cannot be transmitted. A neurolytic block is mainly used for severe chronic pain cases, like pain from cancer or complex regional pain syndrome/CRPS. They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery. (Johns Hopkins Medicine. 2024) (Alberto M. Cappellari et al., 2018)
• The neurosurgeon performs a surgical nerve block that involves surgically removing or damaging specific areas of the nerve. (National Institute of Neurological Disorders and Stroke. 2023) A surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.
• Although neurolytic and surgical nerve blocks are permanent procedures, pain symptoms, and sensations can come back if the nerves are able to regrow and repair themselves. (Eun Ji Choi et al., 2016) However, symptoms and sensations may not return months or years after the procedure.

Different Body Areas

They can be administered in most body areas, including: (Hospital for Special Surgery. 2023) (Stanford Medicine. 2024)

• Scalp
• Face
• Neck
• Collarbone
• Shoulders
• Arms
• Back
• Chest
• Ribcage
• Abdomen
• Pelvis
• Buttocks
• Legs
• Ankle
• Feet

Side Effects

These procedures can have the potential risk of permanent nerve damage. (Anthem BlueCross. 2023) Nerves are sensitive and regenerate slowly, so a tiny error can cause side effects. (D O’Flaherty et al., 2018) Common side effects include:

• Muscle paralysis
• Weakness
• Frequent numbness
• In rare cases, the block could irritate the nerve and cause added pain.
• Skilled and licensed health practitioners like surgeons, pain management physicians, anesthesiologists, and dentists are trained to perform these procedures carefully.
• There is always a risk of nerve damage or injury, but the majority of nerve blocks safely and successfully decrease and help manage chronic pain. (Anthem BlueCross. 2023)

What to Expect

• Individuals may feel numbness or soreness and/or notice redness or irritation near or around the area that is temporary.
• There can also be swelling, which compresses the nerve and requires time to improve. (Stanford Medicine. 2024)
• Individuals may be asked to rest for a certain amount of time after the procedure.
• Depending on the type of procedure, individuals may have to spend a few days in a hospital.
• Some pain may still be present, but that does not mean the procedure did not work.

Individuals should consult with a healthcare provider about the risks and benefits to ensure it is the right treatment.

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References

Johns Hopkins Medicine. (2024). Nerve blocks. (Health, Issue. www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks

NYU Langone Health. (2023). Nerve block for migraine (Education and Research, Issue. nyulangone.org/conditions/migraine/treatments/nerve-block-for-migraine

National Institute of Neurological Disorders and Stroke. (2023). Pain. Retrieved from www.ninds.nih.gov/health-information/disorders/pain#3084_9

Johns Hopkins Medicine. (2024). Chronic pancreatitis treatment (Health, Issue. www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pancreatitis/chronic-pancreatitis-treatment

Cappellari, A. M., Tiberio, F., Alicandro, G., Spagnoli, D., & Grimoldi, N. (2018). Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series. Muscle & nerve, 58(5), 671–675. doi.org/10.1002/mus.26298

Choi, E. J., Choi, Y. M., Jang, E. J., Kim, J. Y., Kim, T. K., & Kim, K. H. (2016). Neural Ablation and Regeneration in Pain Practice. The Korean journal of pain, 29(1), 3–11. doi.org/10.3344/kjp.2016.29.1.3

Hospital for Special Surgery. (2023). Regional anesthesia. www.hss.edu/condition-list_regional-anesthesia.asp

Stanford Medicine. (2024). Types of nerve blocks (For Patients, Issue. med.stanford.edu/ra-apm/for-patients/nerve-block-types.html

Anthem BlueCross. (2023). Peripheral nerve blocks for treatment of neuropathic pain. (Medical Policy, Issue. www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_c181196.html

O’Flaherty, D., McCartney, C. J. L., & Ng, S. C. (2018). Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA education, 18(12), 384–390. doi.org/10.1016/j.bjae.2018.09.004

Stanford Medicine. (2024). Common patient questions about nerve blocks. (For Patients, Issue. med.stanford.edu/ra-apm/for-patients/nerve-block-questions.html