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OHIP Covered Services
Most services are covered by the Ontario Health Insurance Plan (OHIP)
WILDERMAN MEDICAL CLINIC
What is a Nerve Block?
A nerve block is a medical procedure where an analgesic, also known as a pain medication, is injected around a nerve or group of nerves (Wiederhold et al., 2023).
This temporarily prevents the nerve’s ability to send signals to the brain, including pain signals. In some cases, a cortisone anti-inflammatory is added to the injection if there is any concern of an inflammation-related nerve injury.
A nerve block can be used to treat acute or chronic pain, as part of surgery, or as a test to confirm a diagnosis.
Take control of your pain with Nerve Block Injections
Living with chronic pain can feel like an endless battle, but you do not have to fight it alone. At Wilderman Medical Clinic, our nerve block injections offer a comprehensive approach to pain management, targeting the source of your discomfort with precision and expertise.
It is not the first option when dealing with a pain-related issue outside of surgery, as it does not address the underlying cause of the pain and carries the risk of causing further pain and injury. The use of nerve blocks as a part of chronic pain management is considered only if the pain cannot be managed otherwise, or if the medical team is worried about the chronic use of opioid medications.
In some cases, a nerve block can be done using high- or low-frequency electric currents. A high-frequency nerve block is used to manage acute pain linked to muscle spasms or temporary nerve injuries (Avendaño‐Coy et al., 2018). The high-frequency nerve block sends quick bursts of an electric current, usually between 1 and 50 kilohertz (kHz), through electrodes that overwhelm the nerve(s) and prevent any pain signal from being sent. It is considered a safe and non-invasive way to manage acute pain during an individual’s recovery.
A low-frequency nerve block uses the same principle as a high-frequency nerve block, however, the range of the electric current is below 1 hertz, and the frequency of the electric current is much slower (Conde, 2021). While there is still research to be done on this type of nerve block, it is considered a good addition to a chronic pain management plan.
Types of Nerve Blocks
There are several types of nerve blocks used depending on the situation, disorder, or cause of pain (Wiederhold et al., 2023).
- Surgical: This type of nerve block is used as part of surgery to reduce the amount of pain the patient has after the surgery. It can also be used as an alternative to anesthesia if the surgery is done on the hand or foot.
- Temporary Analgesic: A nerve block can be used to block the pain caused by a traumatic injury, such as a broken bone or dislocation. This type of nerve block is temporary and disappears within a day.
- Chronic Pain Management: When a patient has chronic pain caused by a, or group of, nerve(s), a nerve block can help manage the pain while reducing the use of opioids. This type of treatment requires regular injections, with some being provided every two days for the first month.
- Sympathetic Nerve Block: Sympathetic nerves control several unconscious functions; as such, damage to this nerve can cause debilitating pain and health complications. By blocking the signals from the damaged nerve(s), these issues can be controlled and reduced to improve an individual’s quality of life.
How Does it Work?
A nerve block functions by injecting an analgesic medication into the area surrounding the suspected source of the pain. This prevents the nerves from sending pain signals to the brain, which in turn reduces and/or eliminates the pain coming from that area.
Analgesics function by blocking the calcium channels that initiate a neurochemical signal, preventing it from happening (Cohen et al., 2023). It also acts by increasing the requirements for a signal to be sent through the nerve in the first place. Both of these effects mean that the threshold for a signal to be sent through the numbed nerve(s) is significantly increased, reducing the amount of pain signals that arrive at the brain.
Nerve blocks can be used throughout the body to provide accurate and lasting relief with minimal side effects (Wiederhold et al., 2023). Your medical team will determine where a nerve block should be performed based on your symptoms and diagnosis. They will then determine the type of block and analgesic to use.
Medical Applications
The use of nerve blocks includes:
- Acute Pain Management
- Chronic Pain Management
- Surgical Analgesia
- Diagnostic Test
In the case of acute pain management nerve blocks, the procedure is done to control the pain while the underlying cause is identified and treated.
These causes include:
- Broken Bones
- Traumatic Injuries
- Dislocations
- Hernias
- Post-surgery Pain Management (Harkouk et al., 2021)
- Labor/Child Birth
Here are some chronic pain conditions that can be treated with a nerve block:
- Migraines (Wahab et al., 2023; Li & Szabova, 2021)
- Head and Neck Pain (Ismail & Wahab, 2022; Li & Szabova, 2021)
- Cluster Headaches
- Occipital Neuralgia
- Pudendal Neuralgia
- Thoracic spine pain
- Postherpetic Neuralgia
- Trigeminal Neuralgia
- Lumbago (Lower Back Pain)
- Coccydynia
- Abdominal and Pelvic Pain (Wie et al., 2022)
- Chronic shoulder pain
- Chronic knee pain
When a nerve block is used in a surgical setting, it is used to diminish post-surgical pain (Joshi et al., 2016). It is also known as a regional anesthesia or block. This type of nerve block is mostly used in major surgeries where long-term pain is expected during an individual’s recovery.
The use of a surgical nerve block reduces the use of opioids post-surgery. Surgical nerve blocks can be used for:
- Cesarean/ C-section
- Elbow/Shoulder/Knee/Hip Joint Surgery
- Hand/Foot Surgery
- Resetting Broken Bones
- Back Surgery
- Chest Surgery: For example, breast surgery or the insertion of a thoracic tube.
In some cases, a nerve block can be used as a diagnostic tool to identify the source of pain when other tools are unable to do so (Streitberger, 2020).
Diagnostic nerve blocks can be used to diagnose:
- Occipital Neuralgia
- Spasticity/Uncontrolled Muscle Spasms
- Facet joint pain (cervical, thoracic, lumbar)
- SI joint pain
- Pudendal Neuralgia
- Other conditions
This form of nerve block should only be used if no other diagnostic tool has been able to identify the source of an individual’s pain.
As nerve blocks are invasive, they need to be done following a sterile protocol by qualified professionals. The use of an ultrasound to guide the placement of the nerve block is highly encouraged to minimize the risks of nerve injury.
Contraindications
While nerve blocks are considered a safe and minimally invasive pain treatment option, some individuals may be unable to consider this treatment as an option (Royal Victoria Regional Health Centre, 2020, pp. 20-21).
If you have any of the following contraindications, please let your medical team know so they can discuss the safety of a nerve block or consider safe alternatives for your treatment plan:
- Infection at the injection site.
- Regular use of anticoagulant/blood thinner medications. This includes the use of aspirin for heart attack prevention. Depending on the type of anticoagulant, your medical team may still consider a nerve block to be safe for you.
- Coagulation disorders such as hemophilia, vitamin K deficiency, or von Willebrand’s disease.
- Previous nerve injuries at the site of the injection.
- Moderate to severe concussion, or other head trauma.
- A known allergic reaction to analgesics or anesthetics.
- Liver/Renal dysfunction.
Possible Side Effects
Like all treatments, nerve blocks carry some risks and may cause side effects (Royal Victoria Regional Health Centre, 2020, pp. 23–24; Li & Szabova, 2021). The current recommendations to reduce these risks include the use of a guiding tool, like an ultrasound, to guide the injections to the correct area.
This will limit the chances of the analgesic being placed improperly or the nerve(s) being injured during the procedure.
The most common side effects of a nerve block are:
- Bruising/Bleeding/Tenderness at the injection site
- Itching/Rash at the injection site
- Nausea/Vomiting
- Excessive numbness around the injection site
- Minor infection at the injection site
While rare (<0.1%), here are some serious side effects:
- Nerve injury leading to increased pain, paralysis, or reduced motor control
- Systemic toxicity due to a high dose of analgesic
- Excessive bleeding
- Difficulty breathing/talking
- Pneumothorax
- Severe allergic reaction
- Seizure
- Stroke
- Heart attack
The risks associated with a nerve block will differ based on the location of the procedure and the analgesic being used. There are higher risks of serious side effects when the nerve block is performed in the neck, around the spine, or thorax.
However, these are considered very unlikely when performed by a qualified medical professional with a sterile procedure and the appropriate equipment.
Wilderman Medical Clinic
The Wilderman Medical Clinic offers nerve blocks for a wide range of chronic pain disorders, including spinal stenosis, coccydynia, and lumbago.
For a full list of nerve blocks being offered at the clinic, please consult our nerve block injections page.
WILDERMAN MEDICAL CLINIC
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