If you are experiencing neck pain due to whiplash, spinal stenosis, disc herniation or arthritis in the facet joints of the cervical spine, your back and neck specialist will seek to determine the source of the pain. By knowing the exact source of the pain the most effective and long-lasting treatment alternative can be selected. One of the most useful tools in the specialist’s diagnostic armamentarium when dealing with neck pain is the nerve block. The purpose of the diagnostic nerve block is to identify the area causing the pain as precisely as possible. The procedure entails injecting an anesthetic (usually lidocaine to numb the pain) and a contrast agent (to identify the spinal structure) into the affected area. Lidocaine is a fast-acting anesthetic that usually wears off in about two hours. Other slower-acting anesthetics are sometimes used for longer lasting pain relief.
A nerve block can also be very useful in the management of chronic neck pain. The primary difference between a diagnostic and therapeutic nerve block is that the latter contains an anesthetic and a steroid such as cortisone (to reduce swelling). The pain reducing effects of cortisone can last for months. In some cases the specialist may mix morphine or fentanyl (a synthetic narcotic analgesic) with cortisone to obtain increased pain relief. If the nerve block is successful, surgery is not necessary.
Epidural Spine Block
Depending on the objective data, the back and neck specialist may choose to inject an anesthetic and a steroid into the epidural space that exists between the covering of the spinal cord and the inside of the bony spinal canal. An epidural spinal injection is a non-surgical treatment option that may provide long-term relief from neck pain radiating to the arm. The injected medication coats the targeted nerve roots and the outside lining of the facet joints near the area of injection. In some instances the epidural spinal injection can provide permanent relief.
The epidural spine block procedure is performed on an out-patient basis with the assistance of fluoroscopy (x-ray) to monitor the placement of the needle into the epidural space. A small amount of contrast dye is injected to confirm that the needle is placed properly and that the medication is in the area where it’s needed. The procedure usually takes between 15 and 30 minutes.
There is no guarantee that a therapeutic nerve block will work in every instance and there is no way to predict what a particular individual’s outcome will be. Experience has shown that they work about 50% of the time. When they work, a second block is not needed nor is there a need for other treatment (e.g., surgery). In some cases the block is successful but its effectiveness wears out. It is recommended that no more than three blocks be performed per year.
As is the case with all invasive treatment procedures the possibility of side effects exists. Your specialist will describe what these are and provide you with specific after-care instructions for you to follow. In rare instances the specialist may determine it is unsafe to perform a spinal block if certain medical conditions exist.
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