Medial Branch Nerve Block

Yesterday I underwent I procedure called a medial branch nerve block.  I have a herniated disc in my lower back and have had ongoing severe back pain for more than a year now.  When the orthopedic doc I had been seeing told me he didn’t think I should be experiencing so much pain and that he didn’t know what else to do for me, I made an appointment with a specialist at the Cleveland Clinic.  The specialist there pointed out the herniated disc, which was so obvious on the MRI images that even I could see it, despite the fact that the orthopedic doc apparently missed it.  He’d told me I had degenerative disc disease, but the new doc disagrees with that diagnosis.

So anyway, yesterday I had a diagnostic medial branch nerve block, which is a procedure in which the doctor injects pain medication into the spaces around the medial branch nerves, tiny nerves around the discs in the back.  The pain medication is supposed to temporarily prevent the nerves from transmitting pain signals.  If the medial branch nerves are the nerves transmitting the pain signals, then back pain should be significantly reduced.  However, if other nerves are sending the brain pain signals, the procedure may not help much.

If back pain is relieved by the medial branch block procedure, another procedure called a radiofrequency neurotomy can be done.  That procedure involves inserting needles into the spaces around the medial branch nerves and using a small jolt of electricity to burn the nerve endings, which prevents them from transmitting pain signals.  The nerve endings eventually regenerate, but it can take nine months to a year or longer.

If all this sounds rather icky, well, it is.  I mean, the idea of burning my nerve endings sounds pretty painful, plus I think pain serves a purpose.  It warns us that something is wrong, that we’re injuring ourselves in some way.  If the nerves in your hand did not transmit pain signals, for instance, you could accidentally put your hand on a hot stove and be severely burned before you realized what was happening.  But the nerves in my back are sending near-constant pain signals to my brain, and it’s no longer serving the purpose of warning me about injury.  Just rolling over in bed at night is so painful it wakes me up, and rolling over is not akin to burning your hand on a hot stove.

Plus, when you are in enough pain, I guess you’ll be willing to try just about anything for relief.

The procedure yesterday was somewhat painful.  I got two doses of Versed by IV, so I didn’t much care that it was painful, though.  But I got six injections in all, and I didn’t look at the needles because I didn’t want to know, but I can tell you it felt like they were HUGE.  They hurt, but in between injections, I was all relaxed and feeling floppy as a rag doll from the Versed.

Half an hour later, I was able to sit up in bed with no pain.  I think that was the first time I have been able to sit up without pain in more than a year.  I feel like my back is a little bit bruised or something, it feels a little tender where I had the injections, but I’ve had no muscle spasms and none of the sharp, shooting pains I was getting regularly since the procedure.

I see the specialist again in two weeks and we’ll decide where to go from there.  I’m assuming we’ll decide to schedule the radiofrequency neurotomy.  And then I am supposed to start physical therapy, which the doctor has informed me will not be pleasant.  It’s nice to have something to look forward to, isn’t it?

 
If I had my service dog, I would have taken it (him? her? I hate using the word it for a living being) to the hospital with me when I went to have the medial branch nerve block.  I would have kept the dog with me in the prep area, but had it wait with Mike in the waiting room while I was actually having the procedure done.  Once I was back in the recovery room, I would have asked for Mike to bring the dog back to me.  I wouldn’t have been able to control the dog while I was having the procedure done, and seeing me in pain might have frightened the dog.  I would have wanted the dog with me the rest of the time, though.