Persistent neck or low back pain can sometimes come from the small facet joints that help guide movement in the spine. A medial branch block is a targeted injection used primarily to help determine whether those joints are a likely source of pain.
The procedure temporarily numbs the medial branch nerves, which are small sensory nerves that carry pain signals from the facet joints. If your pain decreases during the expected anesthetic window, the response can provide useful diagnostic information and may help determine whether radiofrequency ablation should be considered.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, examination findings, imaging, treatment history, and response to the block to determine what should come next in your care.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is a Medial Branch Block?
A medial branch block is an image-guided injection used to temporarily numb the medial branch nerves that carry pain signals from the facet joints of the spine.
Facet joints are paired joints located along the back of the spine. They help control movement and stability. Like other joints, they can develop arthritis, irritation, or degenerative changes that may contribute to neck or back pain.
Because imaging alone cannot always determine whether a facet joint is actually causing symptoms, a medial branch block is used as a diagnostic procedure. A small amount of local anesthetic is placed near the nerves serving the suspected joint or joints. Your pain response during the expected period of numbness helps your physician evaluate whether those nerves are carrying pain from the facet joints.
A medial branch block does not permanently treat the nerve and is not intended to cure arthritis or reverse degenerative changes. Any relief from the local anesthetic is expected to be temporary.
If the response supports facet-mediated pain, the results may help your physician decide whether a longer-lasting procedure such as radiofrequency ablation should be considered.
Who May Be a Candidate for a Medial Branch Block?
Your pain management provider may consider a medial branch block when your symptoms suggest that one or more facet joints could be contributing to your pain.
You may be evaluated for a medial branch block if you have:
- Persistent neck or low back pain that appears to be primarily axial rather than nerve-related
- Pain that worsens with certain movements such as extension, rotation, or prolonged standing
- Localized pain or tenderness near the spine
- Facet arthritis or degenerative facet changes on imaging that may correspond with your symptoms
- Symptoms that have not improved enough with conservative treatment
- A clinical examination that raises concern for facet-mediated pain
A medial branch block is not the same as an epidural steroid injection. Epidural injections are generally used when inflammation or irritation of a spinal nerve contributes to radiating symptoms, while medial branch blocks are used to evaluate pain that may be coming from the facet joints.
Your provider will review your symptoms, examination findings, imaging, medications, previous treatments, and treatment goals before recommending the procedure.
What Conditions Can Medial Branch Blocks Help Evaluate?
Medial branch blocks are most useful when facet joint pain is suspected. They do not diagnose every cause of neck or back pain.
Conditions and pain patterns that may lead to a medial branch block evaluation include:
Facet Joint Pain
The facet joints help guide movement between the vertebrae. Irritation, inflammation, or degeneration of these joints can contribute to localized neck or back pain. A medial branch block helps determine whether the nerves serving these joints are carrying the pain signal.
Facet Arthritis and Spondylosis
Arthritic and degenerative changes may affect the facet joints over time. These changes can appear on imaging even in people without pain, so the diagnostic block helps your physician determine whether the facet joints are likely related to your symptoms.
Chronic Neck Pain
Some cases of chronic neck pain may arise from cervical facet joints. A cervical medial branch block can be used to test whether those joints are contributing to the pain.
Chronic Low Back Pain
Some cases of chronic low back pain may arise from lumbar facet joints. A lumbar medial branch block can help evaluate this possibility.
Because back and neck pain can also come from discs, spinal nerves, muscles, sacroiliac joints, and other structures, identifying the likely pain generator is an important part of selecting the right treatment.
How Do Medial Branch Blocks Relate to Radiofrequency Ablation?
Medial branch blocks are commonly used before radiofrequency ablation because they provide diagnostic information about whether the targeted medial branch nerves are likely carrying pain from the facet joints.
During a medial branch block, local anesthetic temporarily interrupts those pain signals. Your physician then evaluates how much your typical pain changes and whether the timing of the response matches the expected effect of the anesthetic.
If the block produces the degree and pattern of temporary relief expected under your treatment plan, your physician may discuss radiofrequency ablation. RFA uses controlled thermal energy to reduce pain signaling from the same targeted nerves for a longer period.
Clinical and insurance requirements for proceeding to RFA can vary. Some patients may need more than one diagnostic block before an ablation is considered. A positive block does not guarantee that RFA will provide relief, and a negative block may lead your physician to investigate a different pain source.
Types of Medial Branch Blocks
The location of the block depends on which facet joints are suspected of causing your symptoms.
Cervical Medial Branch Block
A cervical medial branch block targets selected medial branch nerves in the neck. It may be used when the cervical facet joints are suspected of contributing to chronic neck pain or referred pain around the neck, upper back, or shoulders.
Lumbar Medial Branch Block
A lumbar medial branch block targets selected medial branch nerves in the lower back. It may be used when lumbar facet joints are suspected of contributing to chronic axial low back pain.
The exact levels and side or sides treated depend on your symptoms, examination, imaging, and the joints your physician believes are most likely involved.
A facet joint injection places medication into the joint itself. A medial branch block instead places local anesthetic near the small nerves that carry signals from the facet joint. These procedures can serve different diagnostic or therapeutic purposes.
How Does a Medial Branch Block Work?
Before the procedure begins, you will be positioned so your physician can safely access the appropriate area of the spine. The skin is cleaned, and local anesthetic is used to numb the injection site.
Your physician uses fluoroscopy, a form of real-time X-ray guidance, to position a thin needle near the targeted medial branch nerve. Contrast material may be used when appropriate to help confirm positioning.
A small amount of local anesthetic is then injected near the nerve. Because the purpose is diagnostic, the goal is to temporarily interrupt the pain signal without permanently changing the nerve.
More than one medial branch nerve may be blocked during the same session when clinically appropriate because each facet joint receives nerve supply from nearby medial branches.
After the injection, the needles are removed and you are monitored before discharge. Your care team may ask you to record your pain level and ability to perform activities that normally provoke your symptoms during the hours after the block.
What to Expect Before, During, and After a Medial Branch Block
Before the Procedure
Your care team will provide instructions based on your medical history and the specific area being evaluated.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have an active infection, fever, or illness
- Have allergies to medications, contrast material, or other substances
- Are pregnant or may be pregnant
- Have experienced a previous reaction to an injection or local anesthetic
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow the instructions provided by the office regarding eating, drinking, medications, and transportation. If you are preparing for an upcoming visit, our patient forms are available online.
During the Procedure
You may feel a brief pinch or burning sensation when local anesthetic is administered. During needle positioning or injection, some patients notice pressure or temporary discomfort.
Fluoroscopic imaging allows the physician to view the relevant spinal anatomy while guiding the needle near the medial branch nerve.
If you experience intense or unusual symptoms during the procedure, tell your physician immediately.
After the Procedure
Some soreness around the injection site is common. Temporary numbness or a short-term change in your usual pain may also occur.
Because the block is diagnostic, your physician may ask you to track your pain during the period when the local anesthetic is expected to be active. You may be asked to note whether activities that normally cause pain feel different after the injection.
Follow your specific discharge instructions regarding driving, activity, medications, and return to your normal routine. Contact the office if you develop symptoms that concern you.
Risks, Side Effects, and Safety Considerations
Medial branch blocks are commonly performed in interventional pain management, but every injection procedure involves potential risks and side effects.
Temporary effects may include:
- Soreness or bruising at the injection site
- A temporary increase in pain
- Temporary numbness or weakness
- Dizziness or lightheadedness
- Temporary effects related to the local anesthetic
Less common complications can include:
- Bleeding
- Infection
- Allergic or medication-related reactions
- Unintended injection into a blood vessel
- Nerve injury
- Dural puncture or another injury to a nearby structure
The risks vary depending on the area being treated, your anatomy, medications, allergies, and medical conditions.
Your physician will review the potential benefits, limitations, alternatives, and risks that are relevant to your individual situation before recommending the procedure.
How Quickly Should a Medial Branch Block Work?
A medial branch block is designed to provide diagnostic information during the period when the local anesthetic is active.
If the targeted nerves are carrying pain from the facet joints, you may notice a change in your usual pain relatively soon after the injection. The timing depends on the anesthetic used and your individual response.
Your physician may ask you to compare your pain before and after the procedure and to pay attention to activities that normally trigger symptoms.
The amount, timing, and duration of relief are all part of interpreting the result. A medial branch block does not provide a meaningful diagnostic answer for every patient.
How Long Does Relief From a Medial Branch Block Last?
Relief from a medial branch block is expected to be temporary because the local anesthetic wears off.
The duration depends on the medication used and your individual response. For diagnostic purposes, the important information is whether your typical pain decreases during the expected anesthetic window and how the timing of that relief corresponds with the medication.
Some patients may notice relief beyond the expected anesthetic period, while others receive little or no change in symptoms. The block is not intended to permanently treat the facet joint or medial branch nerve.
If the response supports facet-mediated pain, your provider may discuss whether a longer-lasting treatment such as radiofrequency ablation is appropriate.
How Many Medial Branch Blocks Might I Need?
There is no single number of medial branch blocks that applies to every patient.
Depending on your clinical situation, your response to the first block, and applicable insurance requirements, your physician may recommend a second confirmatory block before considering radiofrequency ablation.
The decision is based on factors such as:
- How much your typical pain changed after the block
- Whether the timing of relief matched the expected anesthetic effect
- Whether improved comfort allowed you to perform normally painful movements or activities
- Your diagnosis and examination findings
- Insurance or authorization requirements
If the initial block does not provide the expected response, repeating the same procedure may not be the appropriate next step without reassessing the suspected source of pain.
What Happens If a Medial Branch Block Does Not Work?
A medial branch block that does not meaningfully change your usual pain can still provide useful diagnostic information.
If the response does not support facet-mediated pain, your provider may reconsider the likely source of your symptoms and review your examination findings, imaging, and treatment history.
Depending on your condition, the next step could include:
- Physical therapy or rehabilitation
- Changes to medications
- Additional diagnostic testing or imaging review
- A facet joint injection or another targeted diagnostic procedure when appropriate
- An epidural steroid injection if spinal nerve irritation is suspected instead
- Evaluation of the sacroiliac joint, disc, muscles, or other potential pain generators
- Other interventional pain management options
- Referral for surgical evaluation when clinically appropriate
The goal is to identify the structure most likely responsible for your symptoms and use the response to diagnostic procedures to guide the next step rather than repeating a treatment that did not provide useful benefit.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to medial branch blocks includes:
- Individualized evaluation before recommending a diagnostic procedure
- Fluoroscopic image guidance
- Targeted treatment based on the suspected source of pain
- Careful review of your response after the block
- Coordination with radiofrequency ablation when the diagnostic results support it
- Access to additional pain management options when the facet joints are not the likely pain source
- Care focused on function and quality of life rather than promising a specific outcome
Medial Branch Block Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers medial branch block evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About Medial Branch Blocks
A medial branch block is an image-guided injection that temporarily numbs small sensory nerves called medial branch nerves. These nerves carry pain signals from the facet joints, and the block is primarily used to help determine whether a facet joint is a likely source of neck or back pain.
A medial branch block may be considered when cervical or lumbar facet joint pain is suspected, including pain associated with facet arthritis or degenerative changes. Your provider will determine whether your symptoms and examination findings make the facet joints a likely pain source.
No. A facet joint injection places medication into the facet joint itself. A medial branch block places local anesthetic near the small nerves that carry pain signals from the facet joint. The procedures can be used for different diagnostic or therapeutic purposes.
Local anesthetic is used to numb the skin, but you may still notice a brief pinch, pressure, or temporary discomfort during needle positioning and injection. Experiences vary, and you should tell your physician about intense or unusual symptoms.
The injection itself is generally brief, although the total appointment is longer because of preparation, positioning, the procedure, monitoring, and post-procedure pain assessment.
If the targeted medial branch nerves are carrying pain from the facet joints, you may notice a change in your usual pain relatively soon after the injection. Your provider will consider the timing and amount of relief when interpreting the block.
The relief is expected to be temporary because the local anesthetic wears off. The duration depends on the medication used and your individual response. For diagnostic purposes, the timing and degree of relief are more important than long-term pain reduction.
Some patients may need more than one diagnostic block before radiofrequency ablation is considered. The decision depends on your response to the first block, your clinical situation, and applicable insurance or authorization requirements.
Potential effects include temporary soreness, bruising, increased pain, numbness, weakness, or dizziness. Less common complications include bleeding, infection, allergic or medication-related reactions, unintended injection into a blood vessel, nerve injury, or injury to a nearby structure.
Follow the instructions provided by your care team. Because the block is diagnostic, you may be asked to track your pain and note how activities that normally trigger symptoms feel during the expected anesthetic window.
A block that does not meaningfully reduce your usual pain may suggest that the targeted facet joints are not the primary source of your symptoms. Your provider can reassess other possible pain generators and discuss different diagnostic or treatment options.
Regenerative Spine and Pain Specialists offers medial branch block evaluation and treatment at our Fayetteville, Marietta, and Atlanta, Georgia locations. Our scheduling team will confirm the appropriate location for your evaluation and procedure.
Schedule an Appointment for a Medial Branch Block Evaluation
Persistent neck or low back pain can interfere with work, sleep, exercise, and everyday activities. If your symptoms may be coming from the facet joints, a medial branch block can provide diagnostic information that helps guide the next step in your treatment plan.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, review your previous treatment and imaging when appropriate, and help determine whether a medial branch block or another diagnostic or therapeutic procedure better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.