What is a nerve block?
A nerve block is an injection to treat pain. Doctors give therapeutic nerve blocks to treat back and neck pain, and various other types of acute and chronic pain. Nerve block results vary from person to person. Pain relief can last for several days or several months. This is often enough to help people start a physical therapy or rehabilitation program for more lasting relief. Sometimes, people need to repeat the procedure or have a series of injections to maintain results and complete their treatment plan.
A nerve block is only method of treating pain. Discuss all of your pain management options with your doctor to understand which ones are right for you.
The two main types of nerve block are spinal and non-spinal. Non-spinal nerve blocks are further divided into peripheral nerve blocks and sympathetic nerve blocks.
Spinal nerve blocks
Doctors use these nerve blocks for regional anesthesia and for spinal conditions causing painful symptoms:
Epidural blocks are a type of regional anesthesia to block pain in the chest, abdomen and legs. Doctors use epidural blocks for various surgeries and procedures.
Epidural injections involve injecting medicine around a specific nerve in your spine. They treat pain that starts in the spinal nerves and affects the arms or legs. This is also called a pinched nerve.
Facet joint injections involve injecting medicine into a specific facet joint in your spine. A facet joint, or z-joint, is a joint on the back of your spine where two vertebrae meet. They usually treat arthritic conditions of the spine.
Sacroiliac joint injections involve injecting medicine into the joints between the pelvic bones. They can treat low back, buttock, and leg pain.
Non-spinal nerve blocks
Peripheral nerve blocks:
Brachial plexus blocks involve injecting medicine into the area between your neck and armpit. They can treat pain in the shoulder, arm and hand.
- Occipital nerve blocks involve injecting medicine into the back of the head or base of the skull. They can treat pain from chronic headaches and scalp and neck pain.
Sympathetic nerve blocks:
Lumbar sympathetic blocks involve injecting medicine in the low back near a chain of nerves. They usually treat leg pain from a regional pain syndrome.
- Stellate ganglion blocks involve injecting medicine around nerves in the neck that supply the arms and hands. They can treat a form of regional pain and help increase blood flow in the affected extremities.
Why is a nerve block performed?
Your doctor may recommend a nerve block for two purposes:
Diagnosing the source of pain. Your doctor will inject anesthetic medicine around a specific nerve or spinal joint. If it relieves your pain, then that nerve or joint is the source of your pain. If it does not relieve your pain, then your doctor will look for another source of the pain.
- Treating pain. Your doctor can inject anesthetic or long-acting anti-inflammatory medicine to relieve pain and reduce swelling.
Your doctor may recommend a nerve block for the following conditions:
Who performs a nerve block?
The following specialists commonly perform nerve blocks:
Neurologists and neurosurgeons specialize in problems of the brain and nervous system.
Orthopedic surgeons specialize in treating problems of the bones and joints.
Pain medicine doctors specialize in diagnosing and treating pain and painful disorders.
Physical medicine and rehabilitation doctors specialize in muscle, bone, and nervous system conditions that affect physical and mental ability.
Other specialists who perform nerve blocks:
Anesthesiologists specialize in preventing and relieving pain.
- Radiologists specialize in imaging and image-guided procedures.
How is a nerve block performed?
Your nerve block will be performed in an outpatient setting. It is a minor procedure that involves the following steps:
You will lie face down on a procedure table.
You may have a sedative to help you relax, but you will remain awake to tell the doctor about your pain.
Your doctor will clean your back and numb your skin.
Your doctor will use a special X-ray, called fluoroscopy, to insert a needle into your spine or other area. Fluoroscopy helps your doctor place the needle at the precise spinal joint or nerve.
Your doctor will inject medicine once the needle is in place.
Your doctor may repeat the procedure on another nerve or spinal joint. You can repeat the procedure three times a year if needed. You will likely return in about a week so your doctor can evaluate your pain.
Will I feel pain?
You may feel some pain or pressure when your doctor inserts the needle. You may also feel a mild burning when the doctor injects the medicine. Taking a few long, deep breaths may help you relax. Tell your doctor if any discomfort does not pass quickly.
What are the risks and potential complications of a nerve block?
Complications after a nerve block are not common, but any medical procedure involves risk and potential complications. Complications may become serious in some cases. Risks and potential complications of a nerve block include:
Allergic reaction to the medicine
Numbness, which is usually temporary
Worsening pain, which is usually temporary
Reducing your risk of complications
You can reduce the risk of certain complications by:
Following activity, exercise and lifestyle restrictions and recommendations
Following instructions after the procedure exactly
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Keeping all scheduled appointments
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my nerve block?
The steps you take before your nerve block can improve your comfort and outcome, as well as the safety of the procedure. You can prepare for a nerve block by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Coping with pain and preparing for a nerve block can be stressful. To help relieve stress, make a list of questions to ask your doctor during your office visit and follow-up appointments. It is also a good idea to bring a list of questions to your appointments.
Questions can include:
Why do I need a nerve block? Are there any other options for treating my condition?
How frequently do you encounter complications from this procedure?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my regular medications?
When should I follow up with you?
How should I contact you if there’s a problem? Ask for numbers to call during and after regular hours.
What can I expect after a nerve block?
Knowing what to expect can help you get back to your everyday life as soon as possible.
How will I feel after the nerve block?
You may have some soreness around the injection site. Your doctor may recommend applying ice or taking over-the-counter pain medicines. Tell your doctor if you have more pain, swelling or bruising than expected.
When can I go home?
You will go home soon after your nerve block. Someone needs to drive you home because you may have numbness and, depending on the injection location, you may have difficulty walking for a few hours. You will need to rest for the day, so it is also a good idea to have someone stay with you. Most people resume normal activities the following day.
You will return to your see your doctor after the medicine has had time to work. This can take up to a week. Your doctor may ask you to keep a pain diary to help evaluate your pain and decide whether another injection is necessary.
When should I call my doctor?
It is important to keep your follow-up appointments after a nerve block. Contact your doctor if you have concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Drainage from the injection site
New or unexplained symptoms
Pain that is not controlled by your pain medication, or new pain
Persistent weakness, numbness or tingling in your arms or legs
Rash or skin irritation
Severe or persistent headache or back pain
If a nerve block does not relieve your pain, your doctor will guide you through other treatment options.