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Procedure

The facet is a joint that connects one vertebra (bone of the spine) to another.  The needle is placed over the nerve that
provides sensation to the facet joint.  This nerve is the Medial Branch.  The injection includes both a long-lasting steroid
and a local anesthetic like lidocaine.  The steroid reduces inflammation and irritation and the anesthetic works to numb
the pain.  The entire procedure usually takes less than fifteen minutes.
























Benefits

The greatest success achieved with the use of Medial Branch Blocks is the rapid relief of symptoms.  With pain relief
patients are able to resume their normal daily activities, which is often not achieved with oral medications and physical
therapy.

Another benefit to the use of the MBB is its use as a diagnostic test to see if pain is coming from the joint itself.  If your
pain disappears with the injection then it is clear that the pain originates from the joint.  Therapeutic lumbar MBBs with
local anesthetic and steroids may be effective in the treatment of chronic low back pain of facet joint origin (Manchikanti  
2007).  

The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the
management of chronic spinal pain.  This guideline explains that the facet joint nerve blocks or MBBs are strong in their
accuracy of diagnosing lumbar and cervical facet joint pain (Boswell 2007).



Risks

With minimal risks, MBBs are considered an appropriate and safe non-surgical treatment for many patients who suffer
from back and neck pain. The associated risks with this procedure involve misplacement of the needle.  In order to
prevent this problem, doctors at Arizona Pain Specialists use fluoroscopy to guide their needle.  Potential complications
associated with the procedure include bleeding, infection, and nerve damage.

The other risks of the MBBs may be directly related to the medication injected.  The risks of developing medication side
effects are typically much less than in a person taking oral corticosteroids.  Some of the potential side effects of
corticosteroids include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the
immune system.  Before receiving a facet injection patients should be assessed by their physician to minimize risks
associated with the procedure.

Outcome

MBBs have increased dramatically in the Medicare population from 1994 to 2001 and are becoming even more popular
today (Friedly 2007).  They are being used more frequently because they have provided successful results in the
treatment of back pain.  

A recent study looked at patients with back pain who received MBBs.  At eight weeks of treatment 53% of people reported
improvement of their pain and by six months of treatment over 68% reported the same (Anand 2007).  The duration of
pain relief varies from each individual but if the first MBBs provide relief, then the procedure can be repeated or facet
denervation can be done.



Journal Articles

Evaluation of lumbar facet joint nerve blocks in the management of chronic low back pain: preliminary report of a
randomized, double-blind controlled trial: clinical trial NCT00355914. Manchikanti L, Manchikanti KN, Manchukonda R,
Cash KA, Damron KS, Pampati V, McManus CD. Pain Physician. 2007 May;10(3):425-40 PMID: 17525777

Increases in lumbosacral injections in the Medicare population: 1994 to 2001 Friedly J, Chan L, Deyo R. Spine. 2007 Jul
15;32(16):1754-60 PMID: 17632396

Patients' response to facet joint injection. Anand S, Butt MS. Acta Orthop Belg. 2007 Apr;73(2):230-3 PMID: 17515236

Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV,
Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB,
Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood
JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain
Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025
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Arizona Pain Specialists
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Phone:  480-563-6400
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Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale, phoenix
Medial Branch Blocks (MBBs)
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D


Medial Branch Blocks (MBBs) are a minimally invasive
non-surgical treatment that are used for arthritis related neck and
back pain.  This pain management technique works by reducing
the inflammation and irritation in the facet joints of the spine that
is causing your pain.  An exciting aspect of this pain relief
modality is that if successful a more long-term treatment option -
Radiofrequency ablation of the medial branch can be emplyed.
Pain medicine, pain management, fibromyalgia, Arizona pain, back pain, pain treatment, discography, back pain, neck pain, migraine., headaches, sciatica, muscle pain, Arizona pain center, acupuncture, arthritis, Arizona, Scottsdale, phoenix
Book I  -  Pain Syndromes

Chapter 1     Low Back Pain
Chapter 2     Neck Pain
Chapter 3     Cancer Pain
Chapter 4     Headaches
Chapter 5     Spinal Stenosis
Chapter 6     Sciatica
Chapter 7     Arthritis
Chapter 8     Fibromyalgia
Chapter 9     Motor Vehicle Injuries
Chapter 10   Complex Regional Pain
Syndrome
Chapter 11   Vertebral Body
Fractures
Chapter 12   Hip and Leg Pain
Chapter 13   Diabetic Peripheral
Neuropathy

Book II  -  Interventional Procedures

Chapter 14   Epidural Steroid
Injection
Chapter 15   Facet Injections/Medial
Branch Blocks
Chapter 16   Radiofrequency Ablation
Chapter 17   Spinal Cord Stimulator
Implants
Chapter 18   IntraDiscal
Electrothermal Therapy (IDET)
Chapter 19   
Vertebroplasty/Kyphoplasty   
Chapter 20   Discography
Chapter 21   Percutaneous
Discectomy
Chapter 22   Occipital Nerve Block
Chapter 23   Sympathetic Block
Chapter 24   Stellate Ganglion Block
Chapter 25   Intrathecal Pump
Implants
Chapter 26   Caudal Steroid Injection
Chapter 27   Adhesiolysis
Chapter 28   Cervical Steroid
Injection
Chapter 29   Sacroiliac Joint
Injections
Chapter 30   Celiac Plexus Block
Chapter 31   Head and Neck
Procedures
Chapter 32   Joint Injections
Chapter 33   Continuous Catheter
Nerve Blocks
Chapter 34   Peripheral Nerve
Stimulation/Field Stimulation
Chapter 35   Disc Denervation

Book III   Other Treatments

Chapter 36   Medication Management
Chapter 37   Acupuncture
Chapter 38   Prolotherapy
Chapter 39   Botox
Chapter 40   Massage
Chapter 41   Alternative and
Complementary Medicines
Chapter 42   Exercise and Nutrition
Counseling
Chapter 43   Prayer
Chapter 44   Cognitive Behavioral
Therapy
Chapter 45   Group Therapy
Chapter 46   Biofeedback
Chapter 47   Chiropractic
Manipulations
Chapter 48   Vitamin Supplements
Chapter 49   Customized
Pharmaceutical Formulations
Chapter 50   Hormone Therapy

Frequently Asked Questions