Medial Branch Blocks For Chronic Neck Pain - Do They Work?

Chronic neck pain is very common in the US, with over 30% of the country experiencing neck pain annually. Unfortunately, a large percentage of people who experience neck pain end up with residual neck pain years later (over half).

There have been numerous studies looking at neck surgery for chronic neck pain. Unless there is a radicular component with a pinched nerve or instability of the anatomy, surgery leads to less than satisfactory outcomes.

There are a number of anatomical regions in the neck which can lead to chronic pain. Arthritis in facet joints, upper cervical joints, or injury to cervical ligaments, fascia, or muscles may be pain or headache generators.

Strong evidence has been shown for the accuracy of cervical facet diagnostic injections for diagnosing these joints as a source of neck pain. Usually it's a combination of history, physical examination, and imaging studies including plain x-rays and and MRI. Typically once a diagnosis has been established from the pain doctor of cervical facet syndrome, the initial treatment is actually a diagnostic treatment along with a therapeutic one.

With the diagnostic injection into the cervical facet joints, the magic number for percent pain relief is 80% reduction. This includes the patient being able to perform multiple maneuvers which were painful prior to diagnostic facet joint blocks. At that point, assuming the 80% pain relief is achieved, then insurance companies typically approve additional treatments such as medial branch blocks or intra-articular cervical facet injections.

There is debate over whether or not cervical facet joint medial branch blocks only need numbing medicine or if steroids should be included in the injection. Studies comparing medial branch blocks with lidocaine plus or minus corticosteroid have shown that both are effective, and each injection typically works for about 5 months, providing over 50% pain relief on average.

It can be repeated when the pain relief dissipates, and excellent relief can be expected with another medial branch block. If longer pain relief is desired, the pain doctor may consider doing a radiofrequency ablation, also termed a radiofrequency neurotomy.

A radiofrequency procedure helps deaden the same tiny nerve endings that are treated with a medial branch block injection. The treatment typically lasts for over a year and if the pain returns the radiofrequency procedure may be repeated.

While it's unfortunate that so many patients in the US suffer from chronic neck pain, it's nice to know that treatments exist to provide pain relief. And even better, these treatments are nonsurgical, outpatient, and cost considerably less than a surgical procedure.