Myers Cocktail !
A medial branch block is an injection of an anesthetic near the joints in your spine called facet joints. The injection is targeted towards the nerve that supplies these joints with pain signals; called the medial branch. You may require multiple injections depending upon how many joints are involved. Typically pain and stiffness is the first presenting symptom which prompts your physician to order an MRI. Upon review of the MRI, what is commonly seen is either degenerative changes or hypertrophic appearances of the facet joints.
Medial branch blocks are therefore typically ordered for patients who have pain primarily in their neck or secondary to arthritic changes in the facet joints or for mechanical low back pain. Medial branch block are very useful as they are able to concomitantly provide us with therapeutic results as well as diagnostic information.
One of three things may happen. 1. The pain does not go away - which means that the pain is probably not coming from the blocked facet joints this holds much diagnostic value. 2. All of the pain goes away and stays away for a few hours to a day or so but the original pain comes back in the same location, consisting of the same quality, character, and intensity. This provides temporary pain relief and therapeutic benefit and would mean the block was also of diagnostic value -the perceived pain is coming exclusively from the degenerated or arthritic facet joints. 3. A percentage of pain goes away and stays away for the same time frame. This indicates multiple pain generators in the close proximity. A portion of pain is in fact coming from the facet joints however there is further work up or intervention required in the treatment. Again this means that the block was of temporary therapeutic value - and further diagnostic value.
If a good percentage of pain is mitigated from the medial branch block, an identical injection will be repeated 2 weeks later to ensure no false positives or placebo effects are at play. If identical pain reduction is achieved x 2, a procedure called a rhizotomy or radiofrequency ablation should be considered. Theoretically, this procedure will give the same type of pain reduction however it provides more permanent relief, typically between 6 months to upwards of 2 years.
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Myers Cocktail !
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