Many patients have asked us why we perform nerve blocks to help us understand their pain. So we wanted to explain this in case someone wants to read this BEFORE they come to see us.
What is a peripheral nerve block?
A nerve block is the act of putting a peripheral nerve in the body to sleep so that it does not work. If the nerve does not work, then one will lose sensation and function of the nerve – including pain.
Why would we put a sharp needle into a patient who already has pain? Great question.
There are several reasons why we choose to do this.
- One main reason we perform blocks is to map the nerve that we think is causing the pain that the patient is reporting to us. If we put a nerve to sleep with local anesthesia then that nerve stops working, and sensation and pain in the distribution of the nerve disappear then we can see what that nerve is doing in the patient that stands before us. Guess, what….if the patient’s pain does not go away …then the pain is not coming from that one nerve that was put to sleep.
- IF that pain and sensation do not go away, then what is the next step? Block another nerve. We will then look for another nerve that may be going to the area that continues to bother them. We continue this until we get all the branches or until we prove that the blocks do not work.
- These blocks provide support that these specific nerves ARE or ARE NOT the cause of their pain.
- Sometimes there is an anatomic variation that can explain differences in pain patterns and nerve blocks help us sort that out.
Do the blocks PROVE beyond all shadow of a doubt that we can cure your nerve pain?
Unfortunately no. They are very helpful and we will almost never take a patient to the operating room to remove nerves from a person who did not respond to a block. The strongest words that I use to a patient about the blocks is that they provide GOOD EVIDENCE that these nerves are the culprit. But it does not guarantee success. I will say that if the patient does not respond to a block – then we hardly ever see success if we perform nerve surgery on those patients. This is not rocket science.
Will the numbness I have after surgery when a nerve is removed be just like the numbness I have after a nerve block?
Unfortunately, we can not guarantee that the same blissful absence of sensation or “nothingness” that most people experience after a successful nerve block is identical to what they will experience if we have to remove a nerve in the operating room. Why? Well, the block is a chemical reaction while surgery is a physical cutting of a nerve. They are just very different. One involves an intentional injury to a functional tissue that can try to regrow, while the other is a temporary disruption of the electrical function of the nerve. However, if we can successfully shut off the nerve by physically disrupting the correct nerve and prevent it from regrowing then we can be very successful in treating pain in many circumstances when the nerve is damaged beyond repair.
What is the difference between a “therapeutic nerve block” and a “diagnostic” nerve block?
A therapeutic nerve block is designed to try to treat the pain long-term, while a diagnostic nerve block is designed to try to map the nerve and tell us if that particular nerve is causing the pain. Many physicians will try to add steroids to nerve blocks in an attempt to be “therapeutic” and treat pain long after the numbing medication has disappeared. The steroid is designed to try to decrease inflammation. There are circumstances where this can be helpful and others that have proven unsuccessful. We tailor our approach to the patient and the circumstance.
Does a nerve block hurt?
Well, this is a complicated question. My usual answer to patients…. “It doesn't hurt me… unless you hit me!” Therefore, I try really hard to keep the patient from hitting me while I am performing their block. How do we do that? Well if I had bigger assistants, I could ask them to sit on the patient and pin them down, but that is generally frowned upon.
What we do is educate the patient on what we are doing and how we are going to do it. Fear is one of the main factors of pain. If we can keep fear out of the equation, then we have won half the battle. The next is continued open communication with the patient during the procedure about how the patient is feeling and adjustments are made as needed to the procedure. This helps the patient feel that they are in control of what is going on.
Then we will also use the smallest reasonable needle we can; smaller needles equal less pain. We numb the skin up with icy cold spray and this blunts the pain reflex. We also provide a squeezy ball to hold in case that helps patients “squeeze through” the discomfort. Of course, every patient gets a lollipop after their block, and some get it during the block. Why a lollipop? Well, “a teaspoon of sugar helps the medicine go down.” Seriously, it does!!! Plus it makes a great reward for those who don't scare the rest of the patients out of the office.
For some, it makes a handy “bite block” while the block is performed. Finally, also a family member or friend may be present in most circumstances to help the patient for moral support if they would like to have someone else with them.
All joking aside, nearly every patient who has come in has been able to tolerate the particular blocks that we perform. There are rare exceptions that we have to treat with extra special care and plans can be formulated for those patients.
Do all patients need nerve blocks?
Do I need to take any pain medication before my nerve blocks?
As unpleasant as it is, we do ask that patients who are expecting to have a nerve block do try to come to the office in a significant amount of pain. Why come to the doctor’s office if you don't have pain? Why have a block, if you don’t have pain? We can’t make the pain go away if you don’t have any when you come to the office.
Can I drive after a nerve block?
Could you drive BEFORE the nerve block? If not – we will not let you drive afterward. The only reason why one might not be able to drive after the block would be if we were blocking a nerve that was directly involved in the act of driving. If you can’t step on the gas or brake because the nerve to the foot was put to sleep temporarily and it did not move anymore, then you could not safely drive. You will need to bring a driver. If there are any concerns we are happy to discuss this prior to the injections.
Why do we perform so many of our own blocks and not send patients to pain management?
Well, we do send patients to pain management colleagues frequently if we do not feel that we are able to perform the blocks safely or if we do not have the training to perform that specific block.
Those colleagues are very important to us, and we trust them with our patients. But for the many different blocks that we do perform, we feel that the act of performing ourselves really helps cut down on a tremendous amount of potential miscommunication. There is nothing quite like making a suspected diagnosis, blocking the nerve that we think is the problem, and seeing the patient firsthand describe what they are feeling and what has happened.
We do it, we see it, we write it down, then we can more confidently act on the result. There is far less chance of miscommunication with the patient and with other team members. It puts the power in the patient’s mouth. Assuming the patient is honest with the result of the block, we are able to see the result in real-time instead of getting a report of the block a week or two later and seeing the patient a month after the block when they have possibly forgotten important information.
When we do have our colleagues perform blocks for us, we will always write very important directions to help them to better help us and the patient. We will nearly always contact that particular provider to try to clarify any confusion in order to try to minimize any potential miscommunication. We also encourage that patient to take very careful notes of the experience so that we can compare what the patient states occurred with what the practitioner says occurred to see if they match.
In Maryland, Contact Dr. Eric Williams for peripheral nerve pain surgical treatment
If you think surgery could be a viable option for relieving your nerve pain symptoms, schedule an appointment with Dr. Williams. He can determine if you will benefit from nerve decompression surgery and can design a treatment plan to fit your specific needs. Find out more about nerve surgery by contacting our Baltimore office at (410) 709-3868.