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Medial Branch Nerve Block and RFA - your experiences please?

Cath111CCath111 Posts: 3,702
edited 06/11/2012 - 8:37 AM in Spinal Injections
Hi there. Instead of putting this in my previous "Next step..." post, I decided to start a new one. Why did I just tell you that? I dunno.

Anyway, I'm scheduled for my first diagnostic medial branch nerve block on October 14 and if that works, I'll be scheduling a radiofrequency ablation.

Can you please tell me your experiences with each of these? I'm wondering what to expect with regards to pain during and after each procedure, or any other sensations that you experienced. Also, how did they work for you and how long?

I know everyone is different, but like everybody else, I'm hoping to get some advance ideas of what I might expect.

Thanks for sharing.


  • The medial branch block was great, for about 2 days. The RFA helps me alot and usually lasts 9 months to a year for me. It is not a pleasant procedure and you will not see results right away (takes about 4-6 weeks) but has always been worth having it done. Good luck.
  • My doc swears by the fact that it is imperative to be awake during a rhizotomy. You must be able to tell him when they hit the spot that recreates your pain. He said that if the patient is asleep it is like working blind and taking a guess at which nerves to burn. It seems to be true because the folks that I have seen that were heavily sedated or asleep did not have good results.
  • I'm in the same boat you are in. I've had branch block injections (6 to 8 pokes per visit) in my cervical spine every 2 months since Feb 2009. It provides relief to my neck and shoulders for the day, but does not touch the constant headache in the back of my head. My pain mgmt doc is pressuring me to have the RF procedure. That is when I started searching for info on spine-health.com and from what I've read it seems like it will help about 50% of the time. 5% of the time the pain will actually get worse, especially when performed further up the spine (as in my case). There are a couple of articles on this site about RF you may want to reference for some facts. There is one message on this site from 4/2/09 titled "Burning pain after Radio Frequency Ablation to Neck (RFA)". I don't believe any response had positive feedback about the procedure. It has made me apprehensive to say the least. I'm just trying to figure out what to do myself. If you form any opinion or receive additional info, could you please pass it along as I am also in limbo with the Radiofrequency!
  • Hi Cath,
    I just had my RFA procedure today. I have to say that it went really well. The procedure was easier than my second diagnostic shot which was more painful than the first one. I was awake throughout the entire procedure. They did give me a valium to relax me. My pain dr also injected a shot of some pain medication to the area to help with later pain.
    As of now I am experiencing soreness and a little burning. THe nurse said I would have burning for a few days and then it will settle down.
    Hope this helps and your injections go well.
  • Donna, thank you for sharing your experience. I talked with my doc on Monday and because I didn't have clear positive results from the nerve block, they're trying to decide if it's wise to go ahead with the RFA.

    I had significant relief from my LBP, but the pain down the back of my legs, in my hips and tailbone were much worse after the shots. If we decide to do the RFA anyway, we're hoping that at least the hip pain will go away with the LBP, that it was just a fluke that the nerve block didn't help it.

    I didn't have any sedation for my nerve blocks, per my doc's PA's request, so I told the nurses at the clinic where I had it done that if I come back for the RFA, I'm going to insist on sedation because the blocks hurt so much. Two of them told me, "Oh, you'll have to be sedated, don't worry." Oh...okay...

    RBM, I've read the statistics on RFA and have seen many negative posts about it, but if my doc suggests I have it done, I'll have it done. I'm going to do everything I can to avoid surgery on my lower back. I've got significant issues at L4/5 causing all the pain and a diffuse disk bulge at that level causing the sciatica. I'm going to do whatever necessary to get the most relief without surgery and then I'll probably just live with pain for a while.

    Thanks again for the info, Donna. Please continue to update and let me know how you're doing.

  • Thanks for your reply. Another one of my doc opinions informed me that most pain will return within months of having a surgery. So, I too will try just about anything to avoid a surgery. I seem to notice that the more doctors I go to to get additional opinions, the more varying opinions I get! Oh well, some people in life have heavier burdens to bear. I hope we all will find help, peace, and contentment. Good luck to you!
  • are not near as successful when the patient is sedated. My doc says that it is like working blind or taking a guess at which nerve should be burned if the patient is not alert enough to respond when the nerve that is causing the pain is stimulated. I tend to believe him because I have always been awake and always had good results. On the other hand I have seen folks here that have been sedated and the procedure was not successful for them.
  • I've had mixed results with RFA. I understand and agree with you that if the doc says "let's try this", then we're going to try it. Basically it's a vote of confidence between patient and physician at that point. I applaud you for having that type of relationship with your doc.

    The nerve that I didn't have any good results with (greater occipital), was later found to have some other pathology issues, so I can't even say that that is a fair judge of it not working. All it did was serve to irritate the nerve. However I have had RFA to the lesser occipital and some branches and it was quite successful.

    It is definitely in our own best interest to be alert for these procedures, that way we can make certain that the doc is targeting the right nerve at the right spot.

  • My understanding is that with the nerve block, it was not only to see if I got relief but so that if I did, the doc now knows exactly which nerves he numbed so I won't have to be alert to tell him. That's why I was not sedated for the nerve block.

    However, it could very well be that they mean they will sedate me afterwards to stop the screaming. LOL

    "C", I have 100% confidence in the team of doctors I have. I've been with this spine center for over a year and the only complaint I ever had was that one time I had to wait for over an hour before the doc saw me. I complained to the PA I saw and after that, at each appointment, if I was waiting even five minutes after my scheduled time, someone would come out and tell me how much longer it would be and apologize. I'm sure they put a "Waiting Complainer" sticker on my file. But, hey, the squeeky wheel...yada...yada...yada.

    Thanks everyone for your thoughts and experiences.

  • dilaurodilauro ConnecticutPosts: 9,818
    how did the nerve block go?
    Wasnt for the 19th, did it get rescheduled? I read too fast some times
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I had my nerve block on Oct. 15 (four, actually). Immediately afterwards, I had a little relief from the low back pain but increased pain in the back of my legs, tailbone and hips. They thought this was from the invasiveness of the shots and that those pains should settle down in a few hours.

    I kept an hourly pain diary because whatever relief I had, if any, would last only six to eight hours.

    My LBP was down to a 1 for the rest of the night. However, the pain in my hips and the back of my legs was up to about a 7 the entire time.

    They're still trying to decide if the RFA is worth doing - the PA said if we went ahead with it, we'd hope that the hip pain went away also, that they're hoping it was just a fluke that it wasn't improved with the nerve block.

    I haven't heard back yet, but my lumbar doctor had the flu when I talked to his PA on Monday, so I'm assuming he was out at least most of the week.

    Que sera sera (Picture Doris Day...)
  • I normally do not make comments on procedures that I have and my experiences because as you said everyone is different.

    I have had chronic headaches for my virtually my entire life. We had tried multiple medications, procedures etc to try to relieve the pain.

    Last Friday (10-30-09) I had RFA procedure on my greater occipital nerve. As this is a procedure they do not put you under for I was awake, though I had been given versed.

    I have a very high tolerance for pain and have had multiple blocks done without issue, however, on Friday I can honestly say that I have never experienced pain like I did during that procedure and for about 4 hrs afterwards.

    It felt as though a bomb went off in my head and like my brain was burning. I am not exaggerating and I do not know if something went wrong though my pain doctor said that the procedure went very well. I literally could not keep tears from coming out of my eyes. My husband came into the recovery area and saw me crying and said 'what the hell did you do to my wife, she doesn't cry". I could not get comfortable for hours afterwards and have applied ice packs for the first 72 hours. The pain around my occipital nerve decreased by Saturday afternoon but the pain and swelling at the injection site is still present

    I don't want to scare anyone from having the procedure done, but please do not go into it thinking there will not be pain.. there is, at least for me. My head still hurts but I am not sure if it is from the swelling and injection site pain. I will give it a few more days to see if worked or not. I did not find out until after the procedure that it will only last for 6 - 10 months and after what I went through on Friday I am not sure I would do it again unless I am totally pain free for the next 6 -10 months.

  • Hi there. I had a lumbar medial branch block 3 days ago. My appointment with my dr. For recheck Isn't for 3 weeks. I'm confused as to when I might get "temporary relief" from the injection. From my understanding,I would know if the injection worked within a week. The websites that I keep reading about medial branch blocks say the pain relief is within hours of the injection and to pay close attention to your pain within the hours shortly after the injection(which was kind of hard to do since I had anesthesia). If that's the case, I wonder why I see my dr. In 3 weeks. Can anyone give me any info on this topic. Thanks so very much. cj
  • I just had (two days ago) RFA done on C2-C5. I had a very positive result with the diagnostic procedure, and my doctor said the RFA would be worth it.

    Several years ago, with a different pain doctor, I had RFA done on my occipital nerves. It was a terrifying experience—not so much the procedure (which was just bizarre), but the swelling afterward. I had extraordinary headaches from the procedure, and was miserable for quite a period of time.

    Having had this experience, I changed doctors. When my new doc suggested the neck RFA after the dx procedure, I was happy, but scared. I went into the procedure very apprehensive.

    The procedure was quite painful. But the sedation and the pain med helped a lot.

    I fully expected to spend the next few days incapacitated. Although I'm sore, the procedure went really well, and so far, so good. I'm very pleased with the results.

    Trusting your doctor is paramount, imho. I don't know why the first procedure went so badly, but I do know that, with a different doctor, I was able to get results. The team who does it is what matters. If they can make you "comfortable" in as dreadful an atmosphere as a procedure room—that's excellent. Unfortunately, this is not one of the experiences that you can know about before you try it.

    I just wanted to add that I got the procedure done for two reasons. I have an old injury to the neck, which causes me pain, and I get a lot of headaches and am sure that some of them are referred pain from my neck. I haven't had a headache or used pain medication since the procedure (it's been two days).
  • Has anyone else experienced this? I had RFA 11/8....was sore after....more sore the next day...third day pain increased...and has been increasing each day. I've had an extremely severe headache, bruising, I've developed a lump on the lower right lumbar region (lowest needle site) and pain shooting down my right buttock, never had pain on my left lumbar and I do now, pain also shoots up to thoracic now as well and I didn't have that...the past three days I've now had vaginal bleeding and low abdominal cramping...my bowels have been different and painful as well (not constipation been CP patient for years and take Senakot to regulate)....the doctor that did the procedure is telling me that I will probably take another 3 weeks to heal up because of my Chronic Pain, Fibrymyalgia, Spondylitis issues and the swelling that was previously there in my lumbar region....he was aware of how much pain I was in during the procedure....but then contradicts himself saying that people normally just take an Advil and are fine....I'm NOT fine...and now dealing with vaginal bleeding and cramping...if ANYONE can help shed some light on their experience....if pain worsened each day for them for the following week.....and how long it took for them to be out of procedure pain....all of this pain is NOT the same pain I had prior to procedure...I have also been so tired and I guess you could say just passing out....it's not like sleeping it's like...I could be watching TV or eating dinner and just pass out...the nausea has been uncontrollable (normally Phenergran daily controls it) but it's not and I've been taking Meclazine as well....I have been using TENS, Ice, Heat, Motrin or Lodine, Zanaflex, Oxycontin ER and Roxicodone for break through...but I find that the pain is now more constant than anything on top of all these wonderful things to deal with.....ANY feedback would be great....this is my first go around with all of this...had Medial Branch in Sept...lasted for about 5 hours.....Also was given numbing and steroid injections at same time....6 needles on either side of lumbar region.....the doc and I thought it may have been a reaction from the steroid but he said that should be worn off by now.....I can't wear pants (no waist line or band on area), can't lay on my back, can't sit in a chair because if the back of the chair touches my back it hurts....with the nausea and now the vaginal bleeding/abdominal cramping...my stomach doesn't feel right....

    Thank you in advance!
  • adinachaleseaadinachalese Posts: 7
    edited 06/11/2014 - 2:42 AM
    I am so thankful for this site because it calms me down. I am scheduled for a RFA on 6/30. In the meantime my pain level is a 10 and I'm unable to work. Sitting, standing, and walking is unbearable. The doctors are compationate and caring but getting through who answers the phone is another story. My procedure has been approved through insurance but I'm playing the waiting game. Basically the doctors who did my prior injections have to do RFA because they are familiar with the trigger site. I honestly hate being on these meds and to be told to just 'double up' on your dosage isn't very comforting at all. Anyway thanks for listening.

  • I had the medial branch block recently. It wasn't a big deal. I don't remember the procedure. I was groggy while the sedative wore off. I didn't get a great deal of pain relief so they are not going ahead with RFA. The worst thing was having to fast all day. That was all that bothered me.
  • Try it. I've had RFA procedures twice now, in 5 places, left and right side medial nerves. I'm able to surf, golf and go about my near normal life for up to 16mo after each procedure. I'm given a mild sedative which I don't even need, just before starting. The local anesthesia shots are no big deal. Just a little pinch and pressure. My second time, I watched it on a second monitor. It certainly is better than getting spinal fusion, at this point. RFA can be done many times. So I'm going to continue until a viable alternative comes along for degenerative disk disease/foraminal stenosis.
  • I just had my fourth medial branch block Friday (today is Sunday). I had great relief Friday and Saturday, but today none, and I feel really bad. The first three I had, I had relief for more than a week, so this has thrown me for a loop. So, J.J. Gray - thank you for sharing that your relief only lasted two days. You've given me some peace of mind, which reduces my stress, which may help to reduce my pain level. Unfortunately the only meds I take or have to take are Celebrex and tramadol. I already have a Radiofrequency Ablation scheduled for next month. I am looking forward to it, because I had one 18 months ago with great success and relief.

    To those who are nervous about the Radiofrequency Ablation procedure, I'd like to offer my experience and encouragement. I had it done on the right side at c4-6 for right arm and hand pain that I'd suffered with for almost two years. I had the three medial branch blocks that went well. Then after the ablation, I did have the 5 weeks of skin numbness that the dr mentioned was possible. It neared the level of painfulness, rather than just being bothersome daily. Though once I hit that 5 week mark I was great, and have had full right side pain relief for 18 months! Though the range is 9 mos to 18 mos, I have been elated. I encourage everyone to give it a chance and stay in close and honest communication with your doctor.

    Again, thanks for the shaing in this forum, you have helped me greatly to find peace with this medial branch block that I just had 3 days ago!!
  • I am asking for my friend, Yes she has already called the dr who did the procedure and is more than likely going to urgent care. But I am wondering if any of you has heard of an injection site infection 2 weeks after the medial branch injection? I have been googling and searching this site for an hour now. She had medical branch blocks right side only At C3-C4 and C4-C5. Most of the swelling has gone away. She woke up this morning with huge swelling in the right side of her neck in the same area of the injection site its hot to touch and she has had a low grade fever all day. She has gotten zero relief from this procedure. She has had it done before on her lumbar spine and also had the radio frequency ablation that hasnt even lasted 6 months. She was supposed to have surgery on her neck already but the dr office brought in a new dr and got rid of her old dr and he isnt following anything in her records her old dr had planned for her. So please if anyone has any info or know where I can find info to give her any information to help her out or ease her mind it would be greatly appreciated. Thank you!
  • I'm not sure how to interpret what I am reading here. Are medial branch blocks different than RF ablation? From what I am reading the medial branch block is extremely painful and the outcome just as painful and uncertain. How does RFA factor in? If I am reading correctly RFA appears to work. Overall I cannot get over doctors causing pain to cure pain. What??? I don't understand.
  • I had this procedure done on my lumbar spine, L2-L5. I am a week and half out, and so far...my pain has been significantly reduced. I was sore for a few days, but after that so much better! I my doctor has been exceptional through the entire process, which I think it very important . I have virtually complete degenerative of the cartilage between 4 vertebra, arthritis, sciatica, and stenosis. Surgery is my only other option. But, as of today...I am virtually pain free! If this last for two months or two years, I would do it again in a heartbeat!
    Ann- 40 years old, degenerative spine L3-S1, arthritis of the spine, stenosis.
  • LeahmariaLLeahmaria Posts: 1
    edited 07/11/2015 - 11:34 AM
    i had the procedure done in 5 areas in my spine. I hesitated for over a year but was in so much pain even with strong pain meds I had to do something. I was just existing. Well, first I have to admit it was not a pleasant experience. They cannot deaden all the area because I guess they need to know if they are in the right place. I had two trials and then the procedure. I cried my eyes out (silently). BUT, I believe it has WORKED!!!!! I have less and less pain every morning. This morning I woke up to no pain at all. I still am taking pain meds but not as often and when I do take them they work. I couldn't be happier! I wish I could guarantee all of you the same results, but we are all different . It has been almost two weeks and I feel like a new person. Just remember it is no fun to go through!

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