Nerve blocks are a procedure that aim to reduce or eliminate pain by disrupting nerve activity in a specific region of the body, thereby limiting the severity of pain signals traveling through the area.
These are often minimally invasive procedures that involve injecting specific chemicals into the tissue surrounding a major nerve, or by deliberately damaging portions of that nerve with a precise cut. While this sounds drastic, nerve blocks can save a person from a continued lifetime of debilitating pain. For instance, in cases of chronic neuropathic pain, where nerve damage can cause continuous pain.
While pain can be a good thing, chronic pain usually isn’t. It can occur for a vast variety of reasons, from injury to poorly healed wounds and scarring, damaged nerve endings, hypersensitivity to pain caused by other conditions. As well as a variety of genetic conditions such as kyphoscoliosis, chronic fatigue syndrome, endometriosis, multiple sclerosis, and arthritis. Neuropathic chronic pain specifically refers to pain caused by malfunctions and disorders in the portions of the nervous system. Nerve blocks aim to treat and target this type of pain.
Why a Nerve Block?
The right medication can remedy some pain. Acetaminophen can reduce the severity of pain signals. While anti-inflammatory agents like ibuprofen can help with swollen joints and fever pains. Opioids can target a wide variety of different pains, although they also come with a risk.
However, to target neuropathic pain is not easy. Sometimes, CNS depressants like gabapentin can be effective. But in cases of severe pain, especially after multiple medications have failed, the most reliable and effective method of treatment is a nerve block.
Nerve blocks can either be temporary or permanent depending on how they are applied, and either are elected based on the circumstances surrounding the pain, as well as the patient’s condition. Temporary nerve blocks last for over a day, at which point feeling slowly returns. Permanent nerve blocks are technically permanent, as the damaged nerves can regenerate, sometimes with pain, and sometimes without.
Uses for Nerve Blocks
Additionally, nerve blocks can help chronic pain. It systematically reduces nerve activity in various suspected portions of the body, until the most effective area is located. A nerve block, in conjunction with an electromyography test (testing the muscle’s response to nerve stimulation) can be a useful diagnostic tool in finding out why and how a person’s chronic pain came to be.
Nerve blocks can help chronic pain particularly common in cases of back pain. The pain may occur due to the impingement of one or more nerve roots caused by injury or deteriorating/herniating spinal discs. Spinal discs are robust fluid sacs located between vertebrae, which may rupture or swell due to damage or age, pressing on nearby nerves and causing tremendous pain. Physical therapy and rest can reduce swelling and help the surrounding muscles regain strength and stabilize the spine.
However the pain may continue until the compression has ceased. A nerve block can help chronic pain by temporarily reducing pain while the disc recovers, by injecting an anesthetic agent into the tissue surrounding the nerve. Nerve blocks also have other uses. For example, utilizing a nerve block on the sympathetic nervous system of a specific area can stop excessive sweating.
The Nerve Block Procedure
Nerve blocks typically utilize a long needle to inject a chemical agent into the body. This is usually an anesthetic, a painkiller, or a corticosteroid. In cases where the damage to the nerve is permanent, a neurolytic block can be utilized to permanently damage certain portions of the nerve, utilizing alcohol, phenol, and other similar chemicals. This is for very severe cases of chronic pain, when it’s unlikely that the pain will cease over time.
A third type of nerve block is much more invasive and requires the hand of a neurosurgeon. Surgical nerve blocks involve selectively removing or damaging parts of the body’s nervous system, rather than targeting a nerve with a long needle.
In non-surgical/non-invasive cases, nerve blocks are typically performed while the patient is awake. Local anesthesia is applied for the first injection, and a special liquid is injected into the patient’s body, while imaging technology (like an X-ray machine) is used in conjunction with the liquid to help doctors get a clearer path to the nerve.
A second needle is slowly guided into the specified area, where the chemical agent is injected. Then, the patient is kept under observation and given appropriate medication to deal with any potential side effects, like spinal headaches. Nerve blocks are typically very minimal procedures, and do not take a lot of time.
Risks and Considerations
Nerve blocks are very safe procedures, but there’s always some amount of risk when performing any medical procedure. The most obvious risk is the risk of human error. However, it is important to note specialists perform these procedures often and accidents very rarely occur.
When they do occur, it is likely that the wrong nerve is blocked, or the nerves are accidentally damaged. Even rare is Horner’s syndrome. This is where damage occurs to the sympathetic nerves of the face. The side effects are excessive sweating and drooping eyelids.
Other more common risks and side effects include minor bruising, bleeding, and tenderness in the area. One serious risk is infection, which is why follow-up is critical. If you are in a great deal of discomfort or pain following your nerve block, or if there is excessive bleeding or unusual discharge, contact your doctor immediately.
If the numbness and muscle weakness following the nerve block remains for an excessively long time (over a day) with no sign of fading, contact your doctor.
Procedure Aftercare and Recovery
Pain is a complex issue, and not always something that needs treatment. But when it becomes unmanageable and chronic, finding ways to address it effectively is crucial. However, chronic pain exists in many forms, and there’s no one right way to treat it.
Nerve blocks can help chronic pain, but they aren’t the only tool. After a successful nerve block, it’s important to continue working with your doctor to determine the best path forward. Whether it’s looking at medication, therapy, or a more invasive procedure.