What Spine Conditions Are Nerve Blocks Used For?

Question:What spine conditions are nerve blocks used for? How do they work?
—Orlando, FL

Answer: Nerve blocks are used to treat nerve pain. A common type of nerve pain is radiculopathy, which is pain that radiates (or travels) away from an irritated nerve. For example, an irritated nerve in the lumbar spine (low back) can cause pain to radiate down the leg.

person receiving a spinal injectionRadiculopathy is typically caused by anatomical narrowing of the spine, such as spinal stenosis, which can put pressure on the spinal cord or nerves.

This narrowing can be caused by a herniated disc, which can happen when the inner gel-like fluid (called the nucleus pulposus) of the intervertebral disc starts to push into the outer portion of the disc (the annulus fibrosus), irritating your nerve roots.

Nerve compression from a herniated disc can lead to inflammation around the nerve, and that can lead to radiculopathy.

Your pain may be so severe that oral anti-inflammatory medications or other types of medications might not work for you, and your doctor may recommend a nerve block.

There are many types of nerve blocks that can be used as part of your pain management treatment plan, but one of the most common types is the epidural steroid injection.

Here’s how nerve blocks work: They’re a combination of a local anesthetic and a very powerful steroid that’s injected onto or near your nerves by a pain management specialist. But this isn’t the same kind of steroid that some major league baseball players reportedly use to enhance their batting average.

Corticosteroids are used in nerve blocks, and since they have anti-inflammatory properties, they can reduce the inflammation that’s causing your pain.

There are 2 key benefits of nerve blocks over oral steroidal anti-inflammatory medications you should consider when discussing your back pain treatment plan with your doctor:

  • Only 2% of oral steroidal anti-inflammatory medications actually get to your spine. However, 98% of the steroid injected during a nerve block gets to the specific area of your spine that’s causing your pain.
  • Nerve blocks don't have the side effects associated with oral steroidal anti-inflammatory medications (eg, cataracts, weight gain, or blood sugar issues for people who have diabetes).

Your doctor will determine the amount of steroid used in the nerve blocks based on your pain and other symptoms. For example, according to the American Society of Anesthesiologists, it's safe to take up to 640 mg of kenalog—a type of steroidal injection—over a 12-month period.

The effect of a nerve block—how long it reduces inflammation and pain—varies from patient to patient but will typically last 3 to 4 months. During that time of reduced pain, your doctor may suggest physical therapy to increase your strength—especially your core strength—and to help with muscular reconditioning.

The nerve block may reduce your pain, but it’s the work you put into conditioning your body that will help you manage your pain long-term. Conditioning your body will also help reduce episodes of future pain and can prevent further injury. A stronger body can also prolong the benefits of an injection.

Nerve blocks aren’t the best treatment for managing all pain problems, however. Even when they’re appropriate, they’re usually more effective as part of a comprehensive treatment strategy that includes medications and physical therapy.