Medial Branch Blocks: A Targeted Diagnostic Tool for Chronic Back and Neck Pain
Medial Branch Blocks

Medial Branch Blocks: A Targeted Diagnostic Tool for Chronic Back and Neck Pain

By January 18, 2026No Comments

Table of Contents

  1. Introduction: Finding the Source of Spinal Pain

  2. Understanding Facet Joint Pain: The “Hidden” Cause

  3. What is a Medial Branch Block? The Science Explained

  4. What to Expect: The MBB Procedure at APSI Wellness

  5. Interpreting Your Results: The Diagnostic Power of MBBs

  6. Frequently Asked Questions (FAQ)

  7. Sources and Further Reading

1. Introduction: Finding the Source of Chronic Back and Neck Pain

Chronic pain in the neck or back can be a complex puzzle. While issues like herniated discs or muscle strains are often considered, there is another common culprit that can be difficult to pinpoint with standard imaging alone: facet joint arthritis. When this type of pain is suspected, a precise diagnostic tool is needed to confirm it. This is where a Medial Branch Block (MBB) comes in.

At APSI Wellness, with locations in Cincinnati/Milford, Maysville, KY, and Naples, FL, our board-certified pain specialists specialize in advanced diagnostic and treatment procedures. This guide will explain what a Medial Branch Block is, why it’s a critical step in diagnosing facet joint pain, and what you can expect from the procedure.

2. Understanding Facet Joint Pain: The “Hidden” Cause

Your spine is made up of vertebrae stacked upon one another. Between each vertebra are large discs that act as shock absorbers. However, on the back (posterior) of each vertebra are small, paired joints called facet joints.

Think of facet joints like the guiding rails of a train track. They allow your spine to bend and twist while preventing excessive movement. Like any other joint in your body, they are lined with cartilage and can develop arthritis (facet joint arthropathy) due to wear and tear, injury, or aging.

When facet joints become inflamed or arthritic, they can cause:

  • Localized pain in the neck or back, often described as a deep ache.

  • Pain that worsens with twisting, bending backward (extension), or prolonged standing/sitting.

  • Pain that may radiate to the shoulders, hips, or thighs (but typically not below the knee).

Because facet joint pain often overlaps with pain from other spinal structures, an MBB is used to isolate and confirm the facet joint as the true pain generator.

3. What is a Medial Branch Block? The Science Explained

A Medial Branch Block is a diagnostic injection, not a long-term treatment. Its primary purpose is to provide critical information to your doctor.

Here’s how it works:
The facet joints themselves do not have a direct nerve supply. Instead, they are “wired” by tiny nerves called medial branch nerves. These small nerves carry pain signals from the facet joints to your brain.

During an MBB procedure, a physician uses real-time X-ray guidance (fluoroscopy) to place a small amount of local anesthetic (numbing medication) precisely onto the medial branch nerves that supply a specific, painful facet joint.

The Diagnostic Logic:

  • If your pain is significantly reduced (typically by 70-80% or more) for the duration of the anesthetic, it strongly confirms that the targeted facet joint is a primary source of your pain.

  • If your pain does not improve, it suggests the pain is originating from another structure, such as a disc, muscle, or sacroiliac joint.

This clear “yes or no” answer is invaluable for creating an effective, long-term treatment plan.

4. What to Expect: The MBB Procedure at APSI Wellness

At APSI Wellness, your safety, comfort, and understanding are our top priorities. Here is a step-by-step overview of what to expect:

  1. Comprehensive Consultation: The process begins with a detailed evaluation by one of our pain specialists. We review your history, perform a physical exam, and assess your imaging (MRI, X-ray) to determine if you are a candidate for an MBB.

  2. Preparation: On the day of the procedure, you will have a pre-procedure check-in with our nursing team. You may be asked to temporarily stop certain blood-thinning medications. You should arrange for someone to drive you home.

  3. The Procedure: You will be positioned comfortably on a procedure table. The skin over the injection site is thoroughly cleaned and numbed with a local anesthetic. Using fluoroscopic guidance for absolute accuracy, the physician will advance a thin needle to the targeted medial branch nerves. A small amount of contrast dye may be used to confirm perfect needle placement before injecting the anesthetic. The procedure typically takes 15-30 minutes.

  4. Recovery & Observation: You will rest in our recovery area for a short time. Our team will monitor you and provide post-procedure instructions.

  5. The Pain Diary: This is a crucial part of the process. You will be given a pain diary to log your pain levels in the hours following the procedure. Honest and detailed tracking of your pain relief (or lack thereof) during the time the anesthetic is active (usually 2-6 hours) is the essential data your physician needs.

5. Interpreting Your Results: The Path to a Treatment Plan

Your follow-up appointment is where we interpret the results of your diagnostic block.

  • Positive Result (Significant Pain Relief): This confirms facet joint-mediated pain. The most effective long-term treatment for this diagnosis is often a Radiofrequency Ablation (RFA). RFA uses heat to create a temporary “lesion” on the medial branch nerves, stopping pain signals for 9-18 months or longer. An MBB is always performed before an RFA to ensure it will be effective.

  • Negative Result (Little to No Pain Relief): This is still valuable information. It tells your doctor to look elsewhere for the source of your pain, such as the intervertebral discs, sacroiliac joints, or muscles. This prevents you from undergoing an unnecessary treatment and redirects the diagnostic focus.

6. Frequently Asked Questions (FAQ)

Q1: Is a Medial Branch Block painful?
A: The procedure involves minimal discomfort. The initial skin numbing feels like a small pinch. Most patients feel only pressure during the injection itself. Our team is skilled in ensuring patient comfort throughout the process.

Q2: How long does the pain relief from the injection last?
A: The diagnostic relief from the local anesthetic is temporary, typically lasting between 2 to 6 hours. The purpose is not long-term relief, but to gather information. If the block is successful and you proceed with a Radiofrequency Ablation (RFA), you can expect longer-term pain relief from that subsequent procedure.

Q3: Are there any risks or side effects?
A: MBBs are considered very safe when performed by experienced physicians using image guidance. Potential risks are rare but can include temporary soreness at the injection site, bruising, infection, or a headache. There is a very small risk of nerve damage or allergic reaction. Your APSI Wellness physician will review all risks with you in detail before the procedure.

Q4: Why do I need a diagnostic block before a longer-lasting treatment?
A: It is a critical safety and efficacy step. The nerves targeted in an MBB and RFA are very small and close to other important nerves. A successful MBB proves that (1) the facet joint is the true pain source, and (2) we can safely and accurately target the correct nerves. This ensures that an RFA is the right procedure for you and maximizes its chance of success.

Q5: What if I get partial pain relief from the block?
A: This is an important scenario. Your physician will analyze your pain diary closely. Partial relief may indicate that the targeted facet joint is one of several sources of your pain (e.g., a facet joint AND a disc). It helps guide a more comprehensive, multi-faceted treatment strategy.

7. Sources and Further Reading

  • International Spine Intervention Society (ISIS). Practice Guidelines for Spinal Diagnostic and Treatment Procedures.

  • Manchikanti, L., et al. (2020). “Comprehensive Evidence-Based Guidelines for Facet Joint Interventions in the Management of Chronic Spinal Pain.” Pain Physician.

  • Cohen, S.P., & Raja, S.N. (2007). “Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain.” Anesthesiology.

  • Clinical protocols and patient education materials from APSI Wellness.

If chronic neck or back pain is limiting your life, an accurate diagnosis is the first step to reclaiming your comfort and activity. Contact APSI Wellness to schedule a consultation with a pain specialist and see if a Medial Branch Block is right for you.

APSI Wellness | Comprehensive Pain Management
Cincinnati Location: 5405 DuPont Circle, Suite A, Milford, OH 45150
Maysville Location: 1907 Old Main St, Suite 1, Maysville, KY 41056
Naples Location: 9975 Tamiami Trail North, Suite 1, Naples, FL 34108
Website: www.apsiwellness.com