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Spine and Back Health

Back and leg pain - nerve block

05/30/2008

Question:

I have been having pain in my lower back and right thigh for about a year. My Orthopedic surgeon wanted to replace my hip. After 2 Kenalog injections to the hip joint, which did not provide pain relief, my physiatrist told me that the pain appeared to be originating from the L4-L5 disc. Now he wants me to have a selective nerve root block. Are there other treatments that are less invasive than a nerve block? What is the difference between a Nerve Block and an Epidural? What will happen if I do nothing and continue to endure the pain?

Answer:

Hello, thank you for your question. These are really questions that you need to address to the physician who is planning to do the nerve block.

First of all, you want to make sure the physician doing the procedure knows what they are doing. A large number of physicians, including some family doctors, neurologists, physiatrists, and others take a quick "injections course" on a weekend, and start doing the blocks now and then because they generate revenue. Unless they do at least 3-5 blocks per week, you don't want them doing it. Generally, the best trained are anesthesiologists who specialize exclusively in "pain management" or "non-surgical spine treatment".

As far as other treatments, blocks are part of a treatment program that should be comprehensive, and should include physical therapy and medication. Both a nerve block and an epidural involve injection of a steroid, often mixed with a local anesthetic, into the spine. The difference is that an epidural is injected into the margins of the spinal canal itself, while a "nerve block", also called a "transforaminal epidural injection" involves injecting around a nerve root as it exits the spinal canal on the side of the spine.

I can't tell you what will happen if you do or don't get the nerve block, because I haven't examined you, done a medical history, or seen your MRI. You need to ask your doctor(s) that question, as well as asking the physician doing the block what his/her policy is regarding a spouse being present during the procedure. Good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University