• Diagnostic Cervical Facet Block

    1. What is a diagnostic facet block?

    There are numerous structures in your spine that can cause neck and/or shoulder pain. The facet joints are a frequent cause of neck pain. They are highly innervated with little nerves whose sole job is to provide sensation from them. These are the joints in your spine that allow you to twist and bend forward, backward and sideways. They take a lot of stress and loading over the course of our lives. They may become arthritic enough so that we can even see the degeneration on X-rays or MRI. However, many times we cannot see an abnormality on radiographic studies, although we still believe that these joints are generating all or some of your neck and/or arm pain.

    Chronic pain from these joints really serves no purpose except to detract from your quality of life. The only way to find out if the facet joints are the soured of your pain is to perform a diagnostic facet block. This is a diagnostic block because you will either feel better, meaning that these joints are responsible for your pain, or you won't feel better, meaning that these joints are not generating your pain and we must look elsewhere for causes.

    You will be sent home with a "pain diary" to record how you are feeling after the block. Remember this is only temporary relief that may last hours to a few days. If it appears that you obtained adequate relief from this block, we will consider the next step, which is RF (radiofrequency) ablation/denervation of these same nerves. We will discuss this procedure with you separately.

    Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.

    2. What are the risks of the procedure?

    As with most procedures, there is a remote risk of bleeding, infection, nerve injury or allergic reactions to the medications we use. Some short-term effects may occur, as well. For example, if the numbing medication spreads to a nearby nerve root, part of your arm might feel numb for a few hours. In addition, the injection may cause some soreness in your neck. Using an ice pack should help. Once you complete the pain diary, you can resume taking your usual pain medicines.

    3. What happens during the procedure?

    After checking in and signing a consent form, you will have an IV placed. Please wear loose-fitting clothing. You may be asked to change into a hospital gown.
    In the procedure room, our nursing staff will position you on your stomach on a narrow table. We may sedate you with medication in your IV to make you comfortable. Your neck will be cleaned with iodine and sterilely draped. We will then use an X-ray machine (fluoroscope) to guide the needles into the correct spots. The doctor will numb your skin, which may pinch or sting a little. It is very important to hold still and let us know if we are causing you discomfort.

    We usually block three nerves on each side (six total) through four separate needles by injecting a small amount of local anesthetic at each site. The entire procedure lasts between 10 to 15 minutes, after which you will be taken to the recovery room and discharged shortly thereafter, once your sedation wears off.

    4. What happens after the procedure?

    You will be taken to the recovery room in a wheelchair, where your IV will be removed. You will be discharged home shortly thereafter. It is very important for you to complete the pain diary as accurately as you can. We want to know how your usual pain responded to the blocks. To test the neck, you are encouraged to be as active as you can and to do the things that normally cause you pain. Remember, we are not really masking anything, so you will not hurt yourself. You may have some local tenderness from the needles, which ice may help relieve. Try not to take your normal pain medicines until after the pain diary is complete.

    5. Will I have any restrictions after the procedure?

    Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing.

    6. For what reasons should I call the Pain Management Center after the injection?

    You should call us immediately at 781-744-5090 if you experience any of the following:

    • Severe neck pain that is not relieved with medication and ice
    • New numbness or weakness of the arms
    • Signs of infection in the area of injection

    Things to Do Before the Procedure

    Any dietary restrictions will be discussed on the day the procedure is booked.

    • Take all of your medications as scheduled on the day of the procedure, unless directed otherwise.
    • Think of any questions for us and write them down.
    • Make the nurses and doctors aware of any new changes in your medical condition.
    • Before you come in, let us know if you are taking any blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal) or anti-inflammatories.
    • Please remember to arrange for an adult to drive you home.

  • Make an Appointment

    (781) 744-5090