Diagnosis and treatment of axial neck pain often starts with conservative management which include things like physical therapy and anti-inflammatory medications. In the event these do not help the patient, frequently we will proceed with what is called medial branch blockade. Medial branch blockade is a technique used to diagnose facet mediated pain - or arthritis in the neck. If you look at medical literature, neither physical exam or imaging are necessary to make the diagnosis for facet mediated pain. X-rays, MRI’s and physical exams do not tell you the structure that is causing the problem. How we do this is over the area of greatest tenderness we can do a medial branch block.
The medial branch nerve feeds each joint and we can see where that spot lives under X-ray. What we do is take a tiny needle and place it next to the joint and put in a small amount of local anesthetic. The anesthetic then freezes the joint. We see the patient afterwards and if the procedure has given them relief, we have the patient keep a pain diary and walk around for the day doing things that typically bother the, and rate the severity of pain.
The test is a temporary test used to help diagnose the problem. If the patient has good relief from the single block we always use a comparative block or a second injection with a different anesthetic or numbing medicine down the road. If they have good relief with each injection, then we can do a radio frequency denervation. We take a needle, place it next to the joint and numb the area just like the medial blanch blocks. Once the area is numb, we heat up the tip of the needle and it essentially burns the nerve to create a tiny lesion, stopping the nerve from working. The nerves do grow back in the periphery, however, the area can be retreated in the future.