If you’re in significant pain every day, Dr. Kyle Sebastian wants you to feel better. And his solution may take just five minutes.
The interventional spine specialist at Novant Health Spine Specialists - Greensboro explained what a nerve block is, and how this targeted injection can relieve chronic pain.
A nerve … what?
Your nerves help you move your body parts and carry information to your body about what you see, smell, taste and touch. Your nerves help your body realize when it’s being injured or damaged. For example, if you pick up a box that is too heavy for you, your nerves send pain signals that help your brain coordinate a feeling of pain. This signals you to put the box down, hopefully before you hurt yourself.
Sometimes, your nerves send pain signals that aren’t useful – either because the injury has already happened and you can’t prevent it anymore, or because your body has over-responded to the damage. You may feel pinching, burning or electric shock pain shooting down your legs or arms, or dull, aching or throbbing arthritis pain in lower back, neck, knees and hips.
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If this pain is constant or starts to impact your daily life, your doctor may suggest injecting medication to “block” a particular nerve or a group of nerves from sending pain signals. This lets you get on with your life and the activities you love.
Sebastian uses two main types of nerve blocks, depending on a patient’s needs.
If your doctor knows where the problem is: the therapeutic nerve block
Sometimes, your doctor knows exactly which nerve or group of nerves is spamming you with unhelpful pain signals. In this case, they may perform a therapeutic nerve block.
In this short outpatient procedure, you lie or sit on a table. The affected area will be cleaned and numbed.
Then, using imaging to guide the process, the doctor will use a needle to inject medication – including a numbing medication, steroid medication or both – near the affected nerve.
The injection takes five minutes and provides immediate pain relief. For a typical patient, the relief lasts three to six months, during which time you can get back to all your normal routines. When it fades, patients may come in for another nerve block or move on to another method of pain relief. (More on that below.)
If your doctor needs more information: the diagnostic nerve block
Other times, your doctor may need more details about which nerve or nerves are causing your pain. In this case, your doctor may perform a short-lasting procedure called a diagnostic nerve block, which confirms whether a specific nerve is creating the unhelpful pain signals.
This outpatient procedure is similar to the therapeutic nerve block, where the doctor uses a needle to numb the nerve in question. However, this medication only puts the nerve “to sleep” temporarily — typically, for four to six hours.
During this time period, you go home, and as Sebastian said, “do all the things that normally cause you pain, then call me and report back.” Sebastian asks patients to rate their improvement.
For example, if your pain is 100% gone, then the treated nerve was the source of the pain. If your pain is only 10% gone, then that nerve was probably not the problem nerve.
Once the problem nerve or group of nerves has been identified, you and your doctor can decide what form of pain management will be most effective for your needs. Sebastian said most patients move on to a therapeutic nerve block or something called an “ablation procedure,” which uses heat to destroy the nerves in the affected area for a longer period of time. This decision depends on the type of nerve and the role it plays in your body.
Therapeutic nerve blocks are a good option for patients with carpal tunnel syndrome, pinched nerves in their lower back, arthritis-related low back pain, knee pain or other spine-related pain.
Dr. Sebastian generally advises his patients to wait about three months between therapeutic nerve blocks in the same location to limit the complications that come from too much steroid exposure. There are no hard-and-fast rules about how many a patient can receive in the long run — although typically, the effectiveness of steroid injections wanes over time. At that point, your doctor will look at other options for managing your pain, which could include other minimally invasive options like the ablation procedure or potentially referring to a surgical colleague.
Is this safe?
The first nerve block was performed in 1884 during a dental procedure, and there have been over 130 years of research on them since then.
“The difference today is the technology behind it and the anatomic studies to better refine where we place the medicine and what nerves to target,” Sebastian said.
The needle is scary for some patients, so Sebastian wants you to know that your doctor will use low-dose X-rays or ultrasound imaging to guide where they place the needles.
“It’s not a blind technique,” Sebastian said. “I’m watching exactly where I put my needle and exactly where I put the medication.”
Additionally, some patients are concerned about paralysis or nerve damage, Sebastian said. “I reassure them that it's an everyday procedure, we're done in 5 minutes, and you get up and go home after. It’s low risk for any kind of nerve damage.”
Additionally, if you have diabetes or an active infection in your body or on your skin, these health conditions will need to be well-managed before you can receive a nerve block.
Is a nerve block right for me?
If you are experiencing chronic pain, your doctor will likely recommend low-side-effect, noninvasive options first. These might include physical therapy or medications like anti-inflammatories, muscle relaxants or Gabapentin for nerve-related pain.
If you are still in pain, it may be time to move toward a minimally invasive procedure — like a nerve block. Be aware that, like every procedure, there can be potential for bleeding, infection, damage to surrounding tissues, and the possibility that it may not work as intended. A nerve block is usually covered by insurance.
If you are not benefiting from these procedures and there is significant degeneration or signs of nerve impingement, Sebastian said, you may require surgery.
“It tends to be a stepwise progression,” Sebastian says. “We're increasing in severity as we go along. So, when they come in for the first appointment, I say, ‘What stage is this patient at, what pain are they having, and how can we use all the options in front of us to get them the most pain relief possible?’ Each patient is individualized.”
Although you will need a referral from a Novant Health clinician or external clinician to get an appointment, Sebastian said you can come and see a pain specialist like him at any point. “I can be your first step for talking about conservative measures, or I can be your first step at trying something more invasive.” Pain specialists will partner with your other providers, such as physical therapists, orthopedic surgeons, neurosurgeons or rheumatologists to get the best results for you.
Will it work?
Sebastian wants to be clear that nerve blocks aren’t a permanent fix.
“I never make promises,” he said. “I say ‘This procedure is designed to help your pain. How much it helps is the unknown question. I always hope for 100%.’ Usually, it doesn't go away completely, but it's enough for them to live comfortably and do the things that initially gave them trouble.”
On the flip side, nerve blocks occasionally work better than expected, Sebastian said. “Sometimes people come through and say ‘Hey, I did this nerve block, and it’s still working a year and a half later!’ But more often, we see them every three to six months. In the meantime, they’ve gone to Disney World with their grandkids or gone dancing with their wife — something they hadn’t been able to do before because of their pain.”
