Blocks Pain: A Trusted Ally against Persistent Pain

Persistent pain can be challenging to manage and affect your quality of life. But relief is possible.Nerve blocks relieve pain by interrupting how pain signals are sent to the brain. This is done by injecting medicine near or around a nerve. They are also used to help predict how you’ll respond to longer-term treatments like surgery.

Selective Nerve Root Blocks

Selective nerve root blocks (SNRBs) can help provide relief from pain, weakness, and numbness in your neck, back, or extremities. SNRBs are performed in a sterile environment with fluoroscopy or x-ray guidance. SNRBs start by injecting a numbing medication around the spinal nerve(s) that are believed to be causing your pain. Next, an anesthetic is injected around the nerve to block any pain signals from reaching that nerve. After the anesthetic has been injected, steroid is injected around the anesthetic to help manage the inflammation and swelling of the nerve root and surrounding tissue.

SNRBs can also serve as a diagnostic tool to determine whether or not your spinal nerve is the source of your pain. If numbing the spinal nerve decouples you from your pain, it is a substantial indicator that the spinal nerve is likely a source of your pain.

Your doctor will go through your medical history and current medications or supplements before performing the SNRB. It is crucial for you and your physician to know about all medications you take including over-the-counter medications and herbal supplements. Depending on those medications, some take medications can give you an increased risk for bleeding or bruising.

A SNRB will provide a numbing agent which will last from hours to a few days. Once the numbing source diminishes, your doctor will place the needle, with fluoroscopic guidance into the correct spinal location. A contrast dye may be injected to confirm the needle placement is correct.    

For most, a single SNRB will provide enough pain relief to continue with physical therapy. Patients with multilevel, MRI findings, are unlikely to respond to conservative treatment and are willing to have multiple SNRB injections, the doctor likely will be able to effectively identify the source of their pain. One study found that a diagnostic lumbar selective nerve root block (SNRB) had a sensitivity of 57%, a specificity of 86% and an accuracy of 73%.

Trigeminal Nerve Blocks

Patients suffering severe trigeminal neuralgia (TN) may be able to benefit from a nerve block. A nerve block will anesthetize the trigeminal nerve that is conveying pain signals, therefore eliciting some immediate, short-term pain relief that will enhance the patients quality of life considerably.

A nerve block can be accomplished by injecting a local anaesthetic into the space around the trigeminal nerve down by the upper jaw in the area of the maxillary sinus. It takes about 30 minutes to complete the procedure (including initial consultation), and the procedure is done under local anaesthetic without the need for general anaesthetics.


The duration of a trigeminal neuralgia nerve block varies among people, but often provides significant reduction of pain for a period of time (several weeks). During this time it can also sometimes reduce the amount of pain medications a patient will need for acceptable symptom control.

Trigeminal neuralgia (TN) is characterized by this sudden onset of painful sensations on the face that can be triggered by mild, minimal, or normal activities; resulting in severe, sudden, excruciating pain. This pain often comes with sensations of burning, tingling, or stabbing pain felt across the face and may appear at random. The abrupt, painful sensations are often triggered by a sensation of light, heat, or pressure on the face and can last from seconds to several hours.

To get the individual functioning with TN to be less impacted, clinicians will put individuals with TN on anti-seizure medications that are intended to lessen the pain transmitted to the brain. The common medications that may be used are carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal, Oxtellar XR), and lamotrigine (Lamictal). While these medications are useful for treating TN they present unwanted side effects such as dizziness, drowsiness, memory loss, and dry mouth.

A trigeminal nerve block is a suitable option that doesn’t need the use of ongoing prescriptions. It is a safe, reliable form of treatment that can be useful for both diagnostic and therapeutic purposes. The trigeminal nerve can be numbed for diagnostic purposes, to confirm that trigeminal nerve pain is indeed the source pain of a patient’s pain, to assist with a better diagnostic approach, and to develop a more effective management plan for ultimately sustained pain relief.

Occipital Nerve Blocks

A greater occipital nerve block (GON-block) has been proven to be an effective treatment for various types of headache. The block is typically performed in a clinical or office setting, with ultrasound guidance being used to improve accuracy and safety. After the procedure, some people will have transient soreness at the site of the injection that usually resolves quickly. The GON-block can be used as a single treatment for specific types of headaches or as part of an overall pain management plan for chronic headaches and neck pain.

Occipital nerves travel on the backside of your head where your neck transitions to the spine in your cranium. The nerve becomes irritated, you may feel headache pain that starts at the base of your skull and extends to your forehead, temple, and sometimes behind your ear. This presentation of headache pain is referred to as occipital neuralgia. The occipital nerve pain can occur for multiple reasons, including tight neck musculature, or could also be caused as a result of an injury to the head. For managing the muscle tension that often triggers this pain, some individuals explore muscle relaxants like Pain O Soma 350, which can help relieve spasms and reduce discomfort.

In order to provide a GON-block, the physician will either palpate your neck for the posterior occipital nerve or use fluoroscopy to find it. Then the physician will clean the area, and inject the medication into the subcutaneous space. It is typically a local anaesthetic, like bupivacaine or lidocaine.

Most patients will find headache pain relieved within minutes of getting an occipital nerve block. For migraines the block interrupts pain signals from occipital nerves from getting to the brain, and cluster headaches by blocking the nerves that trigger them.  Amount of time of relief is different for everyone, but can last from hours to months.

Intercostal Nerve Blocks

Intercostal blocks are minimally invasive techniques used to treat pain originating from the ribs and chest wall. They are good management options for rib pain related to trauma, injury and certain conditions such as costochondritis. Neuropathic pain arising from inflamed or irritated nerve pathways in the ribs and chest wall respond well to intercostal blocks.

Intercostal blocks are generally safe for most patients, however, there are contraindications. These include refusal of the procedure, active infection over the injection site and certain medical conditions which may either affect the effectiveness of the anesthesia or increase possible complications. Patients should not receive this block if taking medications for anticoagulants or coagulopathy.

An anesthesiologist or skilled healthcare worker will know how to suitably administer an intercostal nerve block. The provider will use ultrasound to find the insertion site. The provider will cleanse the area, inject the site with a local anesthetic to numb the area, insert the needle (injection needle) into the periosteum and advance toward the rib to block the intercostal nerves at that rib space.

There may be a little localized tenderness or bruising of the area after injection, although that usually subsides quickly. An individual’s pain sensitivity and pain tolerance band has a direct relationship on how long the numbing lasts after the nerve block.

Finding a physician for an intercostal block should focus on experience and specialization in interventional procedures – and familiarity – if possible. This will maximize the possibility that a physician has some experience doing this type of procedure and it is not their first rodeo.

Sympathetic Nerve Blocks

Sympathetic nerve blocks consist of injecting medication along the spine to block these nerves to stop their pain messages. Sympathetic nerve blocks are used for treating many conditions including:

Although the sympathetic nervous system is responsible for things like blood vessels, heart rate, and sweating, it is also a large contributor to neuropathic pain states like complex regional pain syndrome (CRPS or RSD) and sympathetically maintained pain from shingles (postherpetic neuralgia). Sympathetic block injections can be effective for treating visceral, ischemic, and neuropathic pain. Sympathetic blocks can also be used for treatment of certain cardiac arrhythmias including sustained ventricular tachycardia and hyperhidrosis.

In order to do a lumbar sympathetic block, your healthcare provider will prepare you for the procedure by instructing you too fast for a certain amount of hours prior to the procedure and to bring someone with you to drive you home if necessary. You will lie on the procedure table while the medical team prepares the skin by cleaning it with a combination of antimicrobial soap and alcohol. They will imaging your lower back through an x-ray in order to guide the placement of the injection needle and to ensure that the medication is injected as close to the sympathetic nerves as possible. Once the needle is in the correct place, the medication will be injected.

Due to nervous system sensitivity, your healthcare providers will be closely monitoring you before, during and after the procedure.  They will call for a timeout for the interprofessional team, including nurses and surgical assistants, if you’re not having sedation.  Everyone can speak up at this time about any concerns regarding the whereabouts of anatomy, and the safety and wellbeing of the patient.

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