Facet blocks and medial branch blocks
What are facet blocks?
Facet blocks are injections into the facet joints of the spine. These joints connect one vertebra to the next one on the sides of the spine, and can be a cause of pain in the neck or low back in particular. The "block" part means a local anaesthetic is used to "turn off" the pain from the joint itself.
Facet blocks are injections into the facet joints of the spine. These joints connect one vertebra to the next one on the sides of the spine, and can be a cause of pain in the neck or low back in particular. The "block" part means a local anaesthetic is used to "turn off" the pain from the joint itself.
What are medial branch blocks (MBB)?
Medial branch blocks are injections of a local anaesthetic around the small nerves that supply the facet joints of the neck and back. Often done in combination with a facet block, the anaesthetic can go into the joint and around the nerve to switch off the pain.
Medial branch blocks are injections of a local anaesthetic around the small nerves that supply the facet joints of the neck and back. Often done in combination with a facet block, the anaesthetic can go into the joint and around the nerve to switch off the pain.
Is there anything else in the injection?
The injection always has a local anaesthetic, usually lidocaine. 5% dextrose is added to aid the healing of nerves, as this % of dextrose acts to diminish pain. Bicarbonate is used to buffer the anaesthetic so that it doesn't sting. Lastly, only sometimes is a steroid added to the injection if the inflammation is more acute.
The injection always has a local anaesthetic, usually lidocaine. 5% dextrose is added to aid the healing of nerves, as this % of dextrose acts to diminish pain. Bicarbonate is used to buffer the anaesthetic so that it doesn't sting. Lastly, only sometimes is a steroid added to the injection if the inflammation is more acute.
How long does the pain relief last?
This will vary from person to person. The anaesthetic itself usually lasts for an hour or two, but it has a secondary effect. During the time that the anaesthetic is working, all pain from the affected joint is cut off from reaching the brain. This "reboots" the body's computer as it were, and takes away the pain pathway to the brain. It takes a while for the pain to recur - often for several weeks.
This will vary from person to person. The anaesthetic itself usually lasts for an hour or two, but it has a secondary effect. During the time that the anaesthetic is working, all pain from the affected joint is cut off from reaching the brain. This "reboots" the body's computer as it were, and takes away the pain pathway to the brain. It takes a while for the pain to recur - often for several weeks.
Does MSP cover the cost of this procedure?
Yes, both facet blocks and MBB are fully covered by MSP. But if a steroid injection is needed, there will be a medication fee for this.
Yes, both facet blocks and MBB are fully covered by MSP. But if a steroid injection is needed, there will be a medication fee for this.
Is a facet block painful?
It is no more painful than other injections into joints, but it is an injection through the muscles to the joint, so can be very temporarily uncomfortable. The anaesthetic takes effect quickly and afterwards the pain should be lessened although there may be a degree of stiffness.
It is no more painful than other injections into joints, but it is an injection through the muscles to the joint, so can be very temporarily uncomfortable. The anaesthetic takes effect quickly and afterwards the pain should be lessened although there may be a degree of stiffness.
Are there any side effects?
There are side effects from any injection: potential bruising, muscle ache, temporary dizziness, and a very rare chance of infection. Also very rare is the possibility of injection fluid entering a small blood vessel. This risk is lessened considerably by the use of ultrasound guidance for these types of injections.
Typically upper neck facet blocks can cause temporary dizziness, lasting for around 15 - 20 minutes. You should allow time to sit until this passes.
There are side effects from any injection: potential bruising, muscle ache, temporary dizziness, and a very rare chance of infection. Also very rare is the possibility of injection fluid entering a small blood vessel. This risk is lessened considerably by the use of ultrasound guidance for these types of injections.
Typically upper neck facet blocks can cause temporary dizziness, lasting for around 15 - 20 minutes. You should allow time to sit until this passes.
Can I drive afterwards?
This depends on the individual. Most times it is fine to drive, but if you have a long drive, or any anxiety, or upper facets are being injected (that cause temporary dizziness) it is advisable to bring a driver, or to allow time for any dizziness to pass first. For the low back facet injections this is usually not necessary - again unless you have a long drive to make.
This depends on the individual. Most times it is fine to drive, but if you have a long drive, or any anxiety, or upper facets are being injected (that cause temporary dizziness) it is advisable to bring a driver, or to allow time for any dizziness to pass first. For the low back facet injections this is usually not necessary - again unless you have a long drive to make.
Is this the only treatment I will need for facet joint pain?
Unlikely. This injection does not "heal" the joint, although sometimes the pain can go away for a reasonable length of time. If the injection is a success, the next step is to consider a different treatment. This might be prolotherapy or platelet-rich plasma (PRP) to stimulate the production of collagen and aid healing, or to consider radiofrequency ablation (RFA) or cryolysis, ie. the use of heat or cold along with the local anaesthetic, and this procedure is done by an Anaesthetist, not at this clinic. RFA can last for 9 - 12 months and can give a good period of pain relief. It is fully covered by MSP, whereas prolotherapy and PRP are not covered by MSP.
Unlikely. This injection does not "heal" the joint, although sometimes the pain can go away for a reasonable length of time. If the injection is a success, the next step is to consider a different treatment. This might be prolotherapy or platelet-rich plasma (PRP) to stimulate the production of collagen and aid healing, or to consider radiofrequency ablation (RFA) or cryolysis, ie. the use of heat or cold along with the local anaesthetic, and this procedure is done by an Anaesthetist, not at this clinic. RFA can last for 9 - 12 months and can give a good period of pain relief. It is fully covered by MSP, whereas prolotherapy and PRP are not covered by MSP.