Medial Branch Blocks (MBBs)
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Medial Branch Blocks (MBBs) are a minimally invasive non-surgical treatment that are used for arthritis related neck and back pain. This pain management technique works by reducing the inflammation and irritation in the facet joints of the spine that is causing your pain.
An exciting aspect of this pain relief modality is that if successful a more long-term treatment option – Radiofrequency ablation of the medial branch can be employed.
The facet is a joint that connects one vertebra (bone of the spine) to another. The needle is placed over the nerve that provides sensation to the facet joint. This nerve is the Medial Branch. The injection includes both a long-lasting steroid and a local anesthetic like lidocaine. The steroid reduces inflammation and irritation and the anesthetic works to numb the pain. The entire procedure usually takes less than fifteen minutes.
The greatest success achieved with the use of Medial Branch Blocks is the rapid relief of symptoms. With pain relief patients are able to resume their normal daily activities, which is often not achieved with oral medications and physical therapy. Another benefit to the use of the MBB is its use as a diagnostic test to see if pain is coming from the joint itself. If your pain disappears with the injection then it is clear that the pain originates from the joint. Therapeutic lumbar MBBs with local anesthetic and steroids may be effective in the treatment of chronic low back pain of facet joint origin (Manchikanti 2007). The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain. This guideline explains that the facet joint nerve blocks or MBBs are strong in their accuracy of diagnosing lumbar and cervical facet joint pain (Boswell 2007).
Risks of Medial Branch Blocks
With minimal risks, MBBs are considered an appropriate and safe non-surgical treatment for many patients who suffer from back and neck pain. The associated risks with this procedure involve misplacement of the needle. In order to prevent this problem, doctors at Arizona Pain Specialists use fluoroscopy to guide their needle. Potential complications associated with the procedure include bleeding, infection, and nerve damage. The other risks of the MBBs may be directly related to the medication injected. The risks of developing medication side effects are typically much less than in a person taking oral corticosteroids. Some of the potential side effects of corticosteroids include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system. Before receiving a facet injection patients should be assessed by their physician to minimize risks associated with the procedure.
MBBs have increased dramatically in the Medicare population from 1994 to 2001 and are becoming even more popular today (Friedly 2007). They are being used more frequently because they have provided successful results in the treatment of back pain. A recent study looked at patients with back pain who received MBBs. At eight weeks of treatment 53% of people reported improvement of their pain and by six months of treatment over 68% reported the same (Anand 2007). The duration of pain relief varies from each individual but if the first MBBs provide relief, then the procedure can be repeated or facet denervation can be done.
Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R, Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777 Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul 15;32(16):1754-60 PMID: 17632396 Patients’ response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236 Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
Media Branch Block Testimonial
Mary Cook came to Arizona Pain Specialists after suffering from neck and back pain for over 20 years. She had seen other doctors, but didn’t like the approach of simply a pain medication prescription and a send out the door. Finding Arizona Pain Specialists on the web, Mary says her first and all visits exceeded expectations. After updating her MRIs, the experts at Arizona Pain Specialists recommended a medial branch block procedure. Medial branch blocks are a minimally invasive outpatient procedure that is generally used to treat arthritis related neck and back pain by lessening the irritation and inflammation at the source of your pain. A medial branch block usually provides rapid relief. “It was extremely obvious to everyone that my pain was gone,” Mary says. “I went into work, and everyone noticed how I was different; they said they had been able to see the pain in my face before. And now, they could tell I wasn’t in pain any longer.” At both of the Phoenix area Arizona Pain Specialists clinics, medial branch blocks are regularly performed with great success. If you receive relief from this diagnostic procedure, your pain team at Arizona Pain Specialists will help you make an informed decision on a permanent solution.