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Therapeutic Pain Blocks

The relentless pain of an injury or after surgery can be overwhelming. If standard pain-relieving medicines don't work, your healthcare provider may suggest a therapeutic pain block. This is done by injecting pain-relieving medicine into the site of the affected nerve. This injection will block the pain signals the nerve would otherwise send to your brain. If your brain doesn't get the pain signals, you won't feel the pain you would normally feel. Your healthcare provider might also include a steroid in this injection. This will help to control swelling and inflammation around the nerve. This approach can help with short-term pain, like recovery from surgery or injury, or acute pain from damage to the soft organs. It's also commonly used along with other treatments for chronic joint and nerve pain.

How a therapeutic pain block is done

Your healthcare provider might want to do 1 or 2 nerve block tests to find out the best place to inject medicine to control pain. This means the medical team will inject the pain-relieving medicine, or anesthetic, close to the nerve most likely to carry pain signals from the injured area to the brain. If that works to relieve your pain, then that is where the therapeutic block will be applied. If your pain is not eased, your provider may try another location.

Types of therapeutic pain blocks

Cross section of spine showing needle inserted into epidural space in lumbar spine.
Click to Enlarge: Example of epidural insertion

These are common types of therapeutic blocks:

  • Epidural. Many pregnant people get an epidural to ease the pain of labor and childbirth. If you are feeling severe pain in your neck, back, or leg because of inflamed or "pinched" spinal nerves, your healthcare provider may inject a steroid into the epidural space. This is the space near the spinal canal. The injection may be guided by moving X-ray images. Often, the steroid is used along with an anesthetic.  A steroid, such as cortisone, helps reduce inflammation in the area.

  • Facet joint. Injections of a steroid with local anesthetic into the facet joints in the spinal bones, or vertebrae, can help treat back pain from arthritis or injury. Facet joints are the small joints found between each vertebra on your spine. Pain in the neck, middle back, lower back, buttocks, or upper legs can be controlled in this way.

  • Sacroiliac joint. Injecting a steroid with local anesthetic medicine into the sacroiliac joint, the area between the pelvic bones in the lower back, can block pain in the buttocks, upper leg, and lower back.

  • Suprascapular nerve block. This type of block can be useful for chronic pain involving the shoulder that doesn't respond to injections directly into arthritic joints. It can also be used to block shoulder pain that is severe enough to interfere with needed physical therapy.

  • Occipital nerve block. Injection of a steroid with local anesthetic into the occipital nerves in the back of the head can help ease pain from chronic headaches and types of nerve pain.

Nerve blocks can also be used to block pain to a specific area, like the wrist, during surgery for local or regional anesthesia, or after surgery for pain control. Nerve blocks work best if pain is related to a single nerve or a small group of nerves. Other types of pain might not be improved with this approach.

Risks

Nerve blocks are considered safe when done by a trained, qualified provider. But like all procedures, nerve blocks do have some risks. These include:

  • Bleeding

  • Infection

  • Damage to the nerve, causing loss or sensation of loss of strength in the area of the nerve, or more severe pain

  • Itching, swelling, or pain at the injection site

  • Headache

  • Rarely, muscle weakness or paralysis if damage happens to the spinal cord or a major nerve

Limits of therapeutic nerve blocks

Nerve blocks can bring longed-for relief, but they are not a cure for pain. Their effects may only last for a short time. They are often part of a full program that may include oral medicines, exercise, and stretching to help you recover from your injury.

If you are recovering from surgery, the block should last through the early recovery stages. In other cases, make sure you understand when to call your healthcare provider about breakthrough pain. This is sudden pain that happens even when you are taking medicine for pain. 

Online Medical Reviewer: Jimmy Moe MD
Online Medical Reviewer: Maryann Foley RN BSN
Online Medical Reviewer: Raymond Turley Jr PA-C
Date Last Reviewed: 8/1/2021
© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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