Adam Sewell MD


Performed By Top Pain Management Doctors in Fort Smith, Arkansas 

Description of Procedure

The facet joints are the small joints that help stabilize each vertebrae. Medial Branch pain is inflammation arising from the facet joints. There are even smaller nerves stimulating the facets of the spine.  When these nerves are inflamed and irritated, signals of pain are sent to the brain. This is a common cause of mid-to-lower back and neck pain. A procedure that has become more popular is called a Medial Branch Block (MBB). An MBB temporarily reduces or stops those pain signals from reaching the brain.

An MBB is a medical (nerve) block.  It is an injection that disrupts pain and keeps those impulses from reaching the brain. A nerve block helps diagnose the source of a patient’s pain. It may provide temporary relief, and is often used to determine the outcome of a surgery that is meant to permanently block the activity of certain nerves.

When oral medications and physical therapy fail to work, it is often recommended that the patient receive an MBB for facet joint related pain. Medial branch nerves near the facet joints are responsible for small muscles in the neck, mid and lower back. These nerves often cause chronic neck and lower back pain, in addition to having the brain misinterpret the source of the pain and cause referred head pain.

MBB is a minimally invasive treatment and is commonly used to treat lower back pain. The facet joints that are located around the groove of the lower back are called the Lumbosacral medial branch nerves. These nerves are often associated with lower back pain. Up to 45% of patients suffering from lower back pain have inflammation or irritation of their facet joints (Boswell et al, 2007). In one clinical study, 57 patients with lower back pain were given an MBB. After eight weeks, 30 of those patients had relief. Upon reevaluation six months after the initial injection, the number of patients who had relief increased to 39 (Anand et al, 2007).

MBB is also used to treat neck pain.  There are cervical facet joints that are located at the back or side of the head. There has been a recent study that states that up to 67% of patients suffering from head and neck pain can attribute that pain to irritated or inflamed facet joints (Boswell et al, 2007).


MBB treatment is minimally invasive. It gives relief immediately. It is a non-surgical injection that takes an average of 15 to 30 minutes to perform.

After being numbed with a local anesthetic, the site of the MBB is injected with a long-lasting steroid and a local anesthetic. This injection is guided by a live X-Ray (fluoroscopy). This type of injection uses the anesthetic to numb the medial nerve branch. The impulses that caused so much pain are blocked. The steroid reduces inflammation and irritation. It is important for the patient to rest for 20-30 minutes after the injection (Baker). This treatment is considered a success if the patient has a significant decrease in pain. The MBB may be repeated at least two months after the initial injection.  Patients should not receive more than six per year (Manchikanti et all).

When using the MBB to diagnose, patients should not receive more than four injections per year (Manchikanti et al). When the MBB is successful, the patient may be a candidate for radiofrequency ablation, which is a longer-lasting treatment for pain management (Baker). Radiofrequency ablation uses heat to deaden a nerve. This heat is produced by electric currents (RF currents) and creates a lesion on the nerve. This prevents pain signals from reaching the brain.


One of the greatest benefits of having MBBs are that not only do they relieve pain immediately, they are low-risk and minimally invasive. They are very effective with prognostic and diagnostic treatment (Manchikanti et al). Traditional therapy is not very effective when trying to diagnose lumbar and cervical facet joint pain. MBBs have greatly improved diagnosing whether or not the facet joints are causing the patient’s pain. The American Society of Interventional Pain Physicians created a guideline for chronic spinal pain management. They specifically stated that MBBs are extremely beneficial for diagnosing lumbar and cervical facet joint pain (Boswell et al, 2007).

When used as a pain management procedure, an MBB provides pain relief very rapidly. This pain relief will often last from one month up to a year (Boswell et al, 2007). The patient may also be a candidate for radiofrequency ablation if the MBBs are successful.


MBBs are considered a safe procedure, but as with all medical procedures there are associated risks, possible side effects and complications that vary with each patient.

Pain at injection site. The patient might experience tenderness at the injection area for a short period of time as the local anesthetic wears off.

Minor infection. In less than 1% to 2% of patients, minor infections occur.

Increased pain. The patient might experience a worsening of pain symptoms.

Excessive bleeding, or infection. The patient might suffer excessive bleeding, infection and nerve damage as a result of undergoing an MBB treatment while on blood thinning medications, pregnant, allergic to any of the anesthetics used or they have an active infection.

Nerve or spinal cord damage. Very rarely, a patient suffers from nerve or spinal cord damage or paralysis resulting from direct trauma from the needle, from an infection, bleeding resulting in compression or injection into an artery causing blockage (Baker).


When a patient suffers from chronic neck, back and lower back pain, the Medial Branch Block is a very effective treatment for management of that pain. Not only does relief take place very quickly, MBBs are excellent tools that may be used in the prognosis and diagnosis of the patient’s pain. They will also determine if radiofrequency ablation is a worthwhile treatment. Having an MBB is a very low-risk procedure, with very little recovery time. This makes this a very popular pain management solution.


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