Pain Management Procedures
Cervical Medial Branch Blocks and Radiofrequency Ablation
Cervical Medial Branch Blocks and Radiofrequency Ablation
What are these procedures?
Small joints called facet joints link the bones in the back of the neck. Tiny medial branch nerves carry pain signals from these joints. A medial branch block places local anesthetic beside those nerves to test whether a facet joint is the likely pain source. Radiofrequency ablation, or RFA, uses controlled heat through a specialized needle to interrupt the same pain signals for a longer period.
Blocks at the third occipital nerve and the C2-C3 region may be used when upper-neck joints are suspected of causing pain that travels into the back of the head. Similar diagnostic blocks can be performed at other cervical levels for neck pain.
When may it be recommended?
These procedures are usually considered for chronic, mostly axial neck pain - pain centered in the neck rather than electric or shooting pain down the arm - when examination and imaging are consistent with facet-joint pain and simpler treatments have not provided enough relief. Headache arising from the upper cervical joints is another possible indication.
What happens?
For a diagnostic block, you lie on an X-ray table while fluoroscopy guides thin needles to the targeted nerves. A small amount of numbing medicine is injected. You then track how much your typical pain changes while doing normally painful activities. Insurance plans often require one or more clearly successful test blocks before authorizing RFA.
During RFA, the clinician confirms needle position with imaging and usually performs sensory or motor testing. The area is numbed, and the tip of the needle heats a very small section of the nerve.
Recovery and results
Diagnostic relief is intentionally temporary. After RFA, soreness or a sunburn-like feeling can last days or occasionally longer. Pain relief may take one to three weeks to become clear and commonly lasts months. The nerve can grow back, so pain may eventually return and the procedure may be repeated when appropriate.
Important risks
Risks include bleeding, infection, temporary numbness, increased pain, medication reaction, and uncommon nerve injury. Upper-cervical procedures require particular precision because of nearby blood vessels and nerves. RFA reduces pain signaling; it does not reverse arthritis or other structural changes.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.