Nerve block - worth trying?

September 18, 2006 6:38 PM

Has anyone had any experience with having spinal nerve block injections?

I have a couple of discs bulging (cervical spine) - the pain is a good 8/10. My doctor suggested a nerve block (injection of cortisone into the area around the spine) and I'm wondering if my fellow mefites can offer any wisdom.

I'm interested in finding out if they work - how long they take to kick in - how much these things cost and things to watch for.

Also - have heard perjorative things from 'pain management specialists' about 'block shops' - anyone care to comment?

posted by fingerbang to Health & Fitness (8 answers total)

Nerve blocks are a common procedure, and do work, but much better for some than others. I happen to be one of the fortunate ones. I had one lumbar disc bulging and my pain was right about where yours was, with excruciating spasms aggravating by my desk job. I tried stretching, chiro, and medications, all to no avail. Then I had the nerve block. It was painful, and rather disconcerting (as long needles in the spine usually tend to be, I guess) but almost immediately after, the pain vanished like a thunderclap. That was several years ago and I've not had to return for additional treatment since (knock on wood). Obviously, I am glad I did it.

I don't know about "block shops" but treating back pain is such a huge cash generator that I'm not surprised it attracts a lot of quacks and charlatans; the chiro I saw, for instance, failed to diagnose the disc bulge and so needlessly prolonged and quite possibly worsened my problem. I was given my block at a hospital pain center by an MD who was experienced, friendly, and sympathetic. I've since moved, but if I needed one again, I'd definitely go to another hospital-affiliated practice. (As far as cost, insurance covered it, but I don't think it was terribly bad; certainly not as expensive as the chiro course was, or surgery would have been.) Here's more general information about nerve blocks; Whatever treatment you decide, I hope you get on the mend soon.
posted by melissa may at 7:19 PM on September 18, 2006

edit: nerve blocks. Whatever

(dang it)
posted by melissa may at 7:21 PM on September 18, 2006

I had one, and it was a disaster. The injection resulted in a "wet tap" (dural puncture) and I have never ever felt pain like the headache that caused. I was literally banging my head against a brick wall to take my mind off the pain.

It was supposed to be the first in a series, but it was the last. I never went back. The pain from my ruptured discs was less terrifying.
posted by mr_crash_davis at 7:21 PM on September 18, 2006

Be sure to ask how many the person has done. Ask other physicians who they would recommend. It's only as good as the person doing them.

IMNAD. I am in the medical profession. Do you homework. Lots of it.
posted by 6:1 at 8:27 PM on September 18, 2006

I had it done. It works well, but it takes a few days to kick in after injection.

I was looking for the immediate miracle cure, and got a very good delayed reaction after I had bitterly whined and bitched that it was not working. Ultimately, I needed surgery.
posted by JohnnyGunn at 9:04 PM on September 18, 2006

I had two series of three, spaced about six weeks apart. Here's the deal: if it does work, it is not a cure - it is a gift, and (I'm going to be presumptuous here...sorry if this doesn't fit) you need to do with the gift is use your pain-free time to build up your core muscles, lose weight, correct your posture, etc. - all the things that you knew you needed to do before the injections, but were in too much pain to actually accomplish.

Start with something like Pilates, or Robin McKenzie's exercises, or by checking out Sarno's program at http://www.healingbackpain.com/...just about anything that you think would be fun/productive/effective. Start super slow - gentle, gentle, gentle - and be dilligent. Follow the program you've picked. Avoid carrying large weights (and be skeptical of a program that requires you to use weights from the start -your job is to learn to support your own body.) Remember to take Advil or something like that every day. Use an ice pack for 20 minutes after you work out, and up to three or four times a day if you're experiencing pain. Go for at least four 30-minute walks a week. If you were very athletic before you injured yourself, do not resume your program. The only thing you should be gung-ho about is not being gung-ho!

Combine this strengthening program with a weight loss program; and carefully consider your posture and sitting position.

Key: remember that you've been injured, and you're healing. No snowboarding, no wrestling, no crazy power yoga, no cartwheels. You'll get back to your regular activities, but slowly.

If you can do all this over six months to a year - which is about how long those blocker shots last - you'll have built yourself a base of strength that you can continue for years. It doesn't mean you won't get injured again, but you'll be shocked at how quickly you recover - and how much better you feel.
posted by soulbarn at 12:24 AM on September 19, 2006

What Mr Crash Davies described shouldn't put people off. Even the most experienced pain specialist still ocassionally gets a dural puncture, but it is generally resolved by doing a dural "patch" that is they take a small amount of your blood and inject it into the same area and it very quickly covers the leak.
However, obviously there's a possibility of a bad practitioner messing it up originally and then not finding the right spot subsequently.
Here in the UK if that happened I would simply kick up a stink about the original problem and insist that the consultant do the follow-up. They are so worried about litigation they will make sure to get the best member of staff for the job. Pain Therapy is a recognised sub-specialty of Anaesthsia here, so having it done in the local pain clinic is pretty much all one needs to look out for.
My sympathies, some good advice above I hope you find a solution that works for you.
posted by Wilder at 2:22 AM on September 19, 2006

I had a couple, one a standard injection into the spinal column and the second was a transforaminal, where they tried to get the cortisone injected closer to the inflammation . They didn't work, but that's no reason for you not to try it. My doc said that it's not always instantaneous relief -- sometimes it takes a week for the injection to be effective. I had mine done as outpatient surgery in the local hospital, by someone who really knew what he was doing. The first one hurt like hell for a couple of days, and then I was miserable for another four or five. The second one didn't hurt as much or as long, but it didn't work either.

I eventually had surgery for the damage, and the surgeon discovered that the reason the injections didn't work is because there was no inflammation -- it was all physical impingement. The only real complication I had is that one of the injection sites hadn't completely healed by the time I had surgery, and it started leaking during surgery. Then again, the surgery was 4 weeks after the second block.

A competent doctor will tell you that a dural puncture is a possiblity, regardless of the competency of the doctor. It's also possible that the injection won't work at all. The effects may last 3 weeks, they may last 6 months, they may last 9. (My doc has patients who come in every 6 months for injections, and he's had patients who have one and never need another one, and he's had patients like me who have one and 3 months later they're in surgery (yeah, my back was really messed up)...) I'd say that it certainly worth a try, as long as you go with someone who knows what they're doing.
posted by jlkr at 4:44 AM on September 19, 2006