According to the World Health Organization, low back pain affects about 620 million people globally. Low back pain is the leading cause of disability worldwide and affects people of all ages. Physical therapy, lifestyle changes, and psychological support all can help with back pain, but specific pain treatments are often necessary to address the underlying cause.

A medial branch block is a common procedure for diagnosing and treating back pain. This type of nerve block helps doctors determine the source of chronic back pain and may also have therapeutic benefits. The procedure can help them decide on a course of treatment, such as an RF ablation — a more long-term solution to some types of back pain.

What are medial branch blocks?

To understand this procedure, let’s start with joints in our spine, called facet joints. On the back of each vertebrae there are two pairs of facet joints, one pair to interact with the vertebra above it and one pair to link up with the vertebra below. These joints support the spine and allow for bending and twisting of the back.

Each facet joint is served by small medial branch nerves, which carry pain signals from the joints to the brain. When those joints become inflamed, irritated, or injured, the medial branch nerve endings pick up on that and send pain signals through the spinal cord to the brain. You might experience sharp pain, stiffness, limited range of motion, or tenderness, depending on the problem.

Doctors can temporarily halt the transmission of those pain signals by performing a medial branch block, which involves injecting a local anesthetic near the medial branch nerves.

This outpatient injection therapy procedure is fairly simple:

• The patient lies on their stomach on an X-ray table. The doctor cleans the part of the back in question and numbs the skin with a local anesthetic.
• Guided by live-action X-ray cameras, the doctor guides a tiny needle through the skin so that it draws near to the facet joint in question and its medial branch nerves.
• The doctor injects an anesthetic, and possibly a corticosteroid, to numb the medial branch nerves.
• The procedure takes about 10-15 minutes. The patient will be observed for 30-60 minutes and then can be driven home.

A doctor might recommend a second medial branch block procedure in another two or three weeks to confirm the accuracy of the results for diagnosis.

Recovery and follow-up

The patient will be asked to record any changes in pain levels after the procedure. Normal activity, but nothing strenuous, can be resumed the next day. While a shower is OK, soaking in the tub is not a good idea until 48 hours later.

After the procedure, the results can be interpreted in different ways may happen:

• You might not experience any pain relief. This usually indicates that the pain is not coming from the facet joints.
• Your pain goes away but only for a few hours. This typically indicates that the facet joints are causing the pain, which returns when the nerves regain function. You could be a candidate for an RF ablation that would provide longer-lasting pain relief.
• The pain goes away and comes back a few days later but then gets better again. This may occur if a steroid was used in addition to the anesthetic, and it generally indicates that the procedure is providing therapeutic value.

What is RF ablation?

If a medial branch block successfully confirms that the pain comes from the facet joints, your doctor may recommend radiofrequency ablation (RF ablation) for extended pain alleviation.

During this therapeutic procedure, your skilled pain specialist will use radio waves to burn the spinal nerve fibers that transmit the pain signals along your medial branch nerves. The procedure is similar to a medial branch block.

After undergoing an RF ablation, you may feel better right away, but many patients don’t notice any significant improvement in pain for 10 days to 3 weeks. The relief from chronic pain usually lasts anywhere from 6 to 24 months.

You’re likely a good candidate for RF ablation if you:

• Have pain confirmed as coming from a facet joint dysfunction.
• Want long-term pain relief.
• Prefer minimally invasive or alternative therapies.

When to see a specialist

If you experience any of the following, a medial branch block and/or RF ablation may help you achieve lasting pain relief:

• Pain when twisting, bending backward, looking up, sitting for extended periods and/or standing for a long time
• Chronic lower back pain or persistent neck pain
• Stiffness or limited range of motion
• Pain radiating to the buttocks or legs
• Pain that worsens with certain physical activities
• Sacroiliac joint dysfunction

Many physicians recommend medial branch block and RF ablation procedures to help patients with posture correction, better muscle relaxation, and/or endurance building. The best approach to figure out what will work for you is to visit a healthcare provider who specializes in pain management.

A pain specialist can perform a comprehensive pain assessment and several diagnostic tests to develop a customized, holistic approach for treatment that specifically targets your symptoms. In addition to a medial branch block and/or RF ablation, your doctor may recommend dietary adjustments, exercise routines, and other self-care practices to improve your musculoskeletal system.

Get relief from back pain

If you’re experiencing persistent pain, the Interventional Pain Management department at Florida Medical Clinic Orlando Health is here to help. Our team of experienced pain specialists understands the intricacies involved in treating pain. We can use advanced diagnostic tools and minimally invasive procedures to pinpoint the source of your pain and recommend a tailored treatment plan that may include medial branch blocks and/or RF ablation.

About Dr. Spencer

Dr. Andrew Spencer specializes in Interventional Pain Management and has a strong commitment to helping his patients achieve better mobility and comfort. He completed his Emergency Medicine Residency at the University of South Florida – Tampa General Hospital and his ACGME-accredited Interventional Spine and Pain fellowship at Larkin Community Hospital in Miami.

Dr. Spencer specializes in advanced pain management techniques, including ultrasound and fluoroscopic-guided interventions. He customizes all of his treatment options to each patient to ensure the best patient outcomes possible. He also enjoys spending time with his wife and three children, exploring diverse cuisines, traveling, sports, and outdoor activities.

Contact Dr. Spencer today to schedule an appointment by calling (813) 977-6688.