Conditions Treated

When it comes to back pain, the thoracic spine does not get a lot of attention. Consisting of 12 vertebrae, this area is located in the middle and upper part of your back. Ten of the 12 vertebrae connect to the sternum in the front of the body to form your ribcage. This bony armor protects our most vulnerable organs: the heart and lungs, to name two. The remaining vertebrae hold two “floating ribs” that do not connect to the sternum but offer some protection across the side of your body.

The result of this rigid cage is superior protection for vital organs, but reduced flexibility. And this is where the trouble may begin. Because the middle and upper back don’t allow for much movement, any injury or pain in this area can be difficult to treat.

As with all other vertebrae, the facet joints enable what little movement there is in this region to be supported. Winding through each joint is a thin web of medial branch nerves that are responsible for pain signals. If the facet joints are inflamed or otherwise irritated, the resulting pain can be debilitating.

What causes this type of facet joint pain? It most often occurs from these conditions:

• Spondylosis
• Spondylolisthesis
• Chronic chest wall pain

Any injury or deterioration in the facet joint can also cause pain, as can chronic middle back pain with no known cause.

Benefits

Thoracic medial branch blocks benefits go beyond simple pain relief. This procedure can be used as a diagnostic tool, too.

If you are experiencing stubborn, unrelieved pain in your middle or upper back, receiving a medial branch block can help your doctor know if your pain originates in the medial branch nerves. And, if a thoracic medial branch block is successful, you may be eligible to receive a thoracic medial branch radiofrequency ablation for more long-lasting relief.

In addition, medial branch blocks benefits include:

• Short-term pain relief in the middle or upper back
• The potential to avoid more invasive surgery
• A minimally-invasive, outpatient procedure
• A chance to reduce or eliminate the use of prescription pain medications
• Quick recovery with low risk of side effects

Procedure

The thoracic medial branch blocks procedure is done as an outpatient procedure. Because you may receive oral or IV sedation to relax you, make sure to bring a friend or family member to drive you home.

Your thoracic medial branch block is performed with you positioned face down on an examination table. Your doctor cleans and sterilizes the area to be injected and then applies a topical numbing agent. The first injection is a local anesthetic. This keeps you comfortable during the thoracic medial branch block procedure. You might feel a slight pinch of the needle, but the area should soon become numb.

Once the anesthetic is working, your doctor uses fluoroscopic (X-ray) guidance to position the block. They may use a small amount of contrast dye to make sure the medication is covering the targeted medial branch nerves. Once they verify placement, your doctor injects the anesthetic medication.

After this short procedure, you will move to recovery for a few moments (longer if you receive IV sedation) before you are released to go home.

Some patients find that the pain-relieving effects of a thoracic medial branch block wear off in a few days, but others can experience longer pain relief. This is especially true when this procedure is combined with rehabilitative physical therapy exercises.

Recovery

One of the main benefits of this procedure is that the thoracic medial branch blocks recovery period is short and generally easy for patients.

On the day after your thoracic medial branch block, rest and take it easy. You may feel immediate pain relief, but you may also experience a slight increase in pain, followed by a decrease. While you are learning how your body reacts to the procedure, give yourself time to relax. It’s best to keep a pain diary during this time to monitor levels of pain relief. Track the symptoms you experience and your level of pain.

If you experience soreness or swelling at the injection site, apply ice in a 20-minutes-on, 20-minutes-off pattern. Talk to your doctor about taking ibuprofen or other non-steroidal anti-inflammatory drugs for pain. Ask about any other methods you should use to manage pain.

It’s generally okay to take all of your regular medications and eat as you normally would after this procedure. If you receive IV sedation, do not drive or operate heavy machinery for 24 hours. If you experience a high fever, a sharp increase in pain, feel unwell, or have excessive swelling in the area of the procedure, contact your doctor immediately. This might be a sign of infection.

Risks

Although this procedure is minimally invasive and generally recognized as safe, there are side effects and risks to be aware of.

Thoracic medial branch blocks side effects include the following:

• Bleeding at the injection site
• Temporary weakness in the legs
• Bruising
• Temporary increase in pain

In addition, there are rare but sometimes serious thoracic medial branch block risks. These include:

• Pneumothorax (collapsed lung)
• Infection
• Allergic reaction to the contrast dye or medication

Talk to your doctor about any pre-existing medical conditions, medications, or concerns you might have. Work with a highly-qualified pain specialist who understands your unique health circumstances to reduce your overall risk.