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A Million Little Pieces Of My Mind

My First Medial Branch Block Pain Diary

By: Paul S. Cilwa Viewed: 6/20/2024
Occurred: 10/3/2022
Page Views: 883
Topics: #Health #LumbarSpinalStenosis #MedialBranchBlock #Arthritis
Hey, who needs those nerves anyway?

Today was not the best day for me to have the first of my medial branch block tests. I had a lovely weekend road trip with friends, but didn't pay proper attention to my hydration and so, this morning about 4 AM, I awoke with a nasty migraine headache. (Are there any migraines that aren'tnasty?) Still, this test has already been postponed (some of their equipment had broken down or somwething) and I didn't want to put it off any further. After all, the longer I wait for the tests, the longer I'll have to tolerate this back pain, regardless of how the test turns out.

I turned down the option of sedation, partly because I'm guessing it would cost more; and also because it would require my having a driver to take me home. Besides, at this point I'm one tough sunavabitch and it takes a lot of pain to even get my attention.

Medial branch blocks are a minimally-invasive, non-surgical injection for neck and back pain.

First understanding the anatomy of your back can help you learn how these blocks work. To start, your spine consists of vertebrae cushioned by intervertebral discs that are further stabilized by facet joints. These joints allow your spine to twist and flex safely. Running through and innervating each facet joint is the medial branch of the dorsal ramus nerve—the first branching nerve root in the spine.

Over time, and sometimes because of injury or a chronic pain condition, facet joints can become irritated and inflamed. This sends pain signals from the medial nerve to your brain.

A medial branch block reduces inflammation and irritation in the facet joints of the spine, blocking these pain signals. A medial branch block placed directly next to the medial nerve may provide relief when other facet joint injections (into the joint itself) have been unsuccessful.

Medial branch blocks may also be used as a diagnostic tool. For example, patients who find relief from a medial branch block can opt for radiofrequency ablation, a more long-term pain treatment.

Since I wasn't sedated, the whole procedure was brief. The doc gave me six numbing shots, so I wouldn't feel the deeper application of numbing agent on each side of my spine.

The numbing shots definitely got my attention.

And then I got up. The problem is, I was so sick with my migraine that I could barely feel my back at all. It was all about that band of tightness at the back of my neck (where I normally get my headaches.

If this procedure works, I am expected to have no back pain at all for a period of four to six hours. Thus, I was requested to fill out a pain diary, and here it is:

TimePain LevelNotes
11:30 AMBack: 5
Head: 7
Drove to Winco, went shopping (in a cart). Back is still very stiff. Doesn't hurt, exactly; but hard to flex it. Still have migraine.
12:30 PM4Carried groceries upstairs to apartment. Migraine still hurts. Back is still stiff. But I have to lie down b/c headache.
1:30 PM5Made a lunch omelet. Back is still very stiff. Again, not exactly pain but discomfort. (Note: My back was unusually bad when I woke at 4AM with the migraine, especially at the top of my left hip.)
2:30 PM5Rose from nap. Back so stiff I can hardly walk.
3:30 PM3Back less stiff. Headache gone.
4:30 PMSpine: 0
Hip:5
Spine pain gone entirely but hip pain takes over when I walk. And while my spine doesn't "hurt", it is as stiff as concrete.
5:30 PMSpine: 0
Hip:4
Stiffness: 5
Walked dogs. Spine not hurting but walking is difficult, Spine very stiff.
6:30 PMI'm now at the part of the post-migraine thing where the headache is gone and I'm just exhausted and only want to sleep. Still stiff.
Next day,
8:30 AM
6This is later than I was instructed to journal, but it was remarkable enough to note. When walking the dogs, I have to walk them separately because I can't manage them both at the same time. Each dog is a walk downstairs, and around the outside of the pool enclosure; then back up the stairs. In my current shape, this is an effort every time—and by now you'd think I'd just be used to doing it so it shouldn't be an effort. But because of the back pain, it is. And the thing is, now that my spinal pain had returned, I could realize that it had really been absent yesterday. The stiffness and my headache were unpleasant but may not have been related to the procedure—certainly the headache wasn't. So a second test, one done without a concurrent migraine, is probably called for.