Temporary or Permanent Nerve Block for Chronic Pain

A nerve block is a procedure done to interrupt nerve signals that cause pain in those with nerve dysfunction or injury. This may be done for diagnostic or treatment purposes, and its effects can be short- or long-lasting, depending on the type of nerve block that is done.

A temporary nerve block may involve application or injection of a chemical that stops pain signal transmissions for a period of time (think of epidural use during labor and delivery).

Permanent nerve blocks involve cutting or damaging certain parts of a nerve so pain signals cease. These are used in cases like severe back pain or other chronic pain that hasn't improved with other treatments.

This article discusses how nerve blocks can be used to treat chronic pain and what to expect during a nerve block procedure.

How Nerve Blocks Are Used

If your healthcare provider is trying to diagnose a chronic pain condition caused by nerve dysfunction, they may use a nerve block to pinpoint the problem area. 

They might also do electromyography (EMG) and/or a nerve conduction velocity (NCV) test to narrow down the cause of your chronic nerve pain.

Nerve blocks can also treat chronic neuropathic pain such as pain caused by nerve damage or compression. They are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis.

Types of Nerve Blocks

There are three types of nerve blocks: local, neurolytic, and surgical. While all three can be used for conditions that cause chronic pain, only neurolytic and surgical nerve blocks are permanent. These options are only used for severe pain that has not gotten better using other treatments. 

Temporary Nerve Blocks

A local nerve block is done by injecting or applying local anesthetics, such as lidocaine, to a certain area. An epidural is a local nerve block that works by injecting steroids or analgesics into the area around the spinal cord. 

Though common during labor and delivery, an epidural can also be used to treat chronic neck or back pain caused by a compressed spinal nerve. 

Local nerve blocks are usually temporary, although some are repeated over time to help with chronic pain from conditions like arthritis, sciatica, and migraine headaches.

Permanent Nerve Blocks

A neurolytic block uses alcohol, phenol, or thermal agents (e.g., cryogenic freezing) to treat chronic nerve pain. These procedures purposefully damage certain areas of the nerve pathway so that pain signals cannot be transmitted.

A neurolytic block is mainly used for severe chronic pain cases, such as pain from cancer or complex regional pain syndrome (CRPS). They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery.

A surgical nerve block is done by a neurosurgeon. It involves surgically removing or selectively damaging certain areas of the nerve.

Like a neurolytic block, a surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.

Even though neurolytic and surgical nerve blocks are considered to be permanent, the pain can come back if the damaged nerves are able to regrow and repair themselves.

The pain does not always return. If it does, it may not be for months or years after the nerve block was done.

Nerve Blocks for Different Areas of the Body

Nerve blocks can be given in most parts of the body to help with pain, including:

• Shoulders
• Collarbone (clavicle) 
• Arms
• Face
• Scalp
• Neck and back
• Ribcage
• Buttocks
• Chest
• Abdomen and pelvis
• Legs
• Ankle or feet

Risks and Side Effects of Nerve Blocks

Even a temporary nerve block carries the risk of permanent nerve damage. Nerves are sensitive and regrow (regenerate) slowly, so even a tiny error in calculation can cause major side effects.

Common side effects of nerve blocks include muscle paralysis, weakness, or lasting numbness. In rare cases, nerve blocks may actually irritate the nerve more and cause more pain.

Fortunately, skilled and licensed health practitioners (such as dentists, surgeons, pain management physicians, and anesthesiologists) are trained to carefully perform these procedures.

What to Expect After a Nerve Block

You may feel temporarily numb or sore after a nerve block. You may notice some redness or irritation near the area where the needle was. This is usually not permanent and should get better with time.

If you have had a surgical block, you might be asked to rest for a certain amount of time after your procedure. Depending on how the surgery went, you may have to spend a few days recovering in the hospital.

Some pain may still be there after your nerve block, but that does not mean the procedure didn’t work. Some nerve blocks can also cause swelling, which compresses the nerve and requires time to get better.

Summary

A nerve block is a way to temporarily or permanently treat pain. They use chemicals or numbing medications to interrupt nerve signals and relieve pain.

If you have chronic pain, your provider might want to try a nerve block to help diagnose the problem or give you some pain relief. 

While a nerve block is done by a trained healthcare provider, it still comes with risks—including nerve damage that may not get better. You should talk to your provider about the risk and benefits of the procedure to make sure it’s the right treatment for you.