update #8: the war on back pain

Time for another back pain update (and another cute cat picture). This time it's good news.

This week I went for a diagnostic procedure called lumbar medial branch block. The purpose is to determine if my pain is coming from any of the nerve branches coming off the facet joints in my spine. They inject an anesthetic around the nerve branches at several vertebra levels. If the pain stops, then my pain is coming from those joints and I'd be a candidate for radio frequency nerve ablation, which basically kills or "fries" the nerve. If the pain doesn't stop after the branch blocks, then that's not where it's coming from and there's no sense in trying the ablation.

So I went in for the procedure on Monday. It was pretty much the same as when I went for the epidural cortison injections: no NSAIDs for five days before the procedure and nothing to eat or drink four hours beforehand. I had to lay face-down on the table and they used fluoroscopy to guide the needles to the injection sites in real-time. A numbing agent was injected at each site and then they did eight injections–four on each side of the spine (L2 through L5). There was some discomfort, but it didn’t hurt anywhere near as much as the epidural cortisone injections I had earlier in the year. I was instructed to do home and do all the things that would normally aggravate my pain, which is easy since sitting is what causes it for me. That, and standing in one spot for more than 10 minutes or so. I was out of the office in 20 minutes, measured from the time they called me from the lobby to the time I left. I had to keep a pain log for five hours and report the level of pain and the percentage of improvement.

I sat at my home desk for FOUR HOURS mostly without back pain. That’s huge for me, because normally I'm starting to hurt after about 10 minutes or so. My hips and upper legs ached from sitting from so long, but there was almost no back pain. When I got up from my desk for the bathroom and a few other things, I actually felt the sciatic nerve pinching every time I took a step with my left leg, but didn’t feel all the other pain I normally feel. I guess the pain coming from the joints (and not knowing it) kind of skewed how I was feeling and I just assumed it was all from the pinched sciatic nerve. The anesthetic wore off by Tuesday night, which is what is supposed to happen, but it was a somewhat blissful couple of days!

I went into this without really any hope that it work since other things haven’t worked very well up until now. Well, it DID work! It also made me realize that I have pain not only from that sciatic nerve, but from the joints as well. Overall, I would estimate I got about a 75% reduction in pain.

I go back for my follow-up in a couple weeks, so I plan to tell them I want the ablation. I'm wondering, though:  how do they know which nerve to kill? They did eight injections spanning the L2 through L5, so how would they know which one to kill? Do they do another branch block procedure for only certain areas? Guess I'll find out in a couple weeks!