Unblocking the Mystery: Understanding Neck Pain Blocks

Every year, 30% of adults in the United States experience neck pain. 50% of these individuals will continue to experience persistent pain in the neck. 

Most individuals may find relief in medications and conservative treatments like physical therapy. But some may continue to suffer from the debilitating pain and turn to more intense forms of treatment. One of these treatments is pain blocks, also known as nerve blocks.

If nothing helps with your neck pain, you might be considering getting one. To help inform you, we’ve researched countless journals on pain blocks, their possible safety risks, and how they can help relieve your neck pain.

What Is A Nerve Block For Neck Pain?

A pain block or nerve block is a medical procedure used to prevent or treat pain due to a damaged or inflamed nerve. This procedure involves injecting medication into a nerve or group of nerves. When a nerve block is used to treat neck pain, they are commonly called “cervical plexus blocks.”

These medications “turn off” your nerves and prevent them from sending pain signals to your brain. This can offer short-term or long-term relief from neck pain. A nerve block may prevent pain, such as in surgical procedures, or treat chronic pain.

Before we dive deeper into nerve blocks for neck pain, we need to have a short primer on the “cervical plexus.” This group of nerves in your neck can serve as the targets for pain blocks.

The cervical plexus is a network of nerves that supply your neck and some parts of your upper torso. It is mainly made up of the branches of the C1-C4 spinal nerves and emerges out of the posterior triangle of your neck.

The cervical plexus nerves leave your spinal column and enter the space surrounded by the “deep cervical fascia.” A fascia is a layer of connective tissue that surrounds and supports your muscles, blood vessels, and nerves.

Without getting too detailed, the neck has two fascias, the superficial cervical fascia, and the deep cervical fascia. This help divides the cervical plexus into deep, superficial, and intermediate cervical plexuses. 

Types of Nerve Blocks For Neck Pain

Nerve blocks can be divided into non-surgical or surgical blocks. Non-surgical blocks involve the use of medications, while surgical nerve blocks cut off the nerve. 

Cervical Plexus Block 

Cervical plexus blocks can be used to prevent or relieve pain in the different structures of the head and neck. And like the cervical plexus, cervical plexus blocks can be divided into:

Deep Cervical Plexus Block

The deep cervical plexus includes and involves nerves that are found in the deepest layer of the deep cervical fascia. The deep cervical plexus supplies nerves into the deeper structures of your neck, such as the muscles. It even supplies the diaphragm, an essential muscle for breathing. Because of this, deep cervical plexus blocks are highly risky.

Intermediate Cervical Plexus Block

An intermediate cervical plexus block injects drugs into the most superficial layer of the deep cervical fascia. Since it avoids the deeper tissues such as muscle or veins, it has fewer complications compared to deep cervical plexus blocks.

Superficial Cervical Plexus Block

The superficial cervical plexus comprises the “terminal branches” or the ends of your spinal nerves. These terminal branches emerge behind your sternocleidomastoid muscle (SCM) and supply the skin of your neck.

Usually, approximately 10-15 mL of a long-lasting local anesthetic is used for this procedure.

What Is A Cervical Selective Nerve Root Block?

A cervical selective nerve root block (SNRB) is a type of nerve block that targets a specific cervical nerve. It is often used to treat neck pain that results from pinched nerves. Aside from providing pain relief, selective nerve root blocks can also help identify the damaged nerve causing your neck pain.

What Is A Cervical Epidural Block?

A cervical epidural block is the injection of medication into the epidural space around the nerves of your neck. The epidural space is the space between the dura mater (a thin layer of tissue that covers your spine and brain) and the bones of your spine.

What Are The Surgical Nerve Blocks?

If your neck pain does not respond to non-surgical pain blocks, your doctor may suggest surgery to block the pain signals. Surgical nerve blocks include:

• Neurectomy - a nerve block in which a peripheral nerve is cut off or removed. This is only performed in extremely rare cases of chronic pain where medication or non-surgical nerve block does not work.

• Rhizotomy - is similar to a neurectomy except that the roots of your spinal nerves are cut off instead of peripheral nerves.

What About Sympathetic Blockades?

While some consider sympathetic blocks strictly surgical nerve blocks, they can actually be done through surgery or medication.

A sympathetic nerve block is a form of nerve block that targets your sympathetic nerves. These nerves are responsible for your body’s flight-or-fight or stress response. Because of this, sympathetic blocks can be used to treat pain that results from an abnormal stress response.

Your sympathetic nerves gather outside your spine and form “ganglions,” which are found all over your body. The area in which a sympathetic nerve block is performed depends on the location of your pain.

For example, if the pain is in the upper torso (such as neck pain), the medication is injected into your “stellate ganglion.” You can find this group of sympathetic nerves on either side of your neck.

Like the other non-surgical nerve blocks, a sympathetic block may involve local anesthetics to block the pain signals. A "sympathectomy" may be performed in cases where your pain persists despite the use of these drugs. A sympathectomy is similar to a neurectomy but specifically targets your sympathetic nerves.

What Is The Difference Between Surgical And Non-Surgical Nerve Blocks?

The main difference between surgical and non-surgical nerve blocks is in how long their effects last. As we mentioned earlier, non-surgical or pharmacological nerve blocks use drugs to block the nerve from sending pain signals. With this in mind, the relief you feel may only last as long as the drug acts on your body.

Meanwhile, in surgical nerve blocks, the nerve causing you pain is cut off or destroyed. Because of this, it is also considered a “neurolytic block.” This permanently stops the nerve from sending pain signals and offers long-lasting relief. 

Other forms of neurolytic blocks include:

• Chemical blocks use chemicals like alcohol to damage or destroy the nerve.
• Thermal blocks use extreme heat or cold to destroy the target nerve.

Although neurolytic blocks offer more long-lasting pain relief, they are only used in severe cases since they are riskier.

How Is A Cervical Nerve Block Done?

A cervical nerve block usually involves the following steps:

1. The skin surrounding the injection site is cleaned using a disinfectant.
2. A local anesthetic is then applied to the area so that you won’t feel any pain.
3. Once the area is numb, the doctor will insert the needle with the help of imaging devices such as an ultrasound or CT scan. This is to ensure that the needle is not too shallow or too deep and that the medication is distributed in the right area.
4. Once the doctor confirms that the needle is in the right place, they will inject the medication.
5. You will then be transferred to the recovery room and monitored for adverse side effects or reactions.
6. If the procedure was done for diagnostic purposes, you will be asked whether you feel less pain. This will help confirm if the target nerve was responsible for your neck pain.

The entire procedure usually takes less than 30 minutes. If you do not exhibit any adverse reactions to the drugs, you will be allowed to go home and be advised to take things easy for the rest of the day.

What Drugs Are Used In Nerve Block Injections?

There are a number of drugs that can be used for nerve blocks. These drugs may be injected alone or in combination with other medications. The drugs commonly used in nerve blocks are:

• Local Anesthetics 
  • These are drugs that cause numbness in a small area of your body. This causes you to not feel pain without losing consciousness. These include medications like lidocaine and bupivacaine.

• Steroids
  • These drugs can help ease inflammation and may help heal damaged nerves. These drugs also act as “adjuvants.” Adjuvants are drugs that help enhance the pain-relieving effects of other medications. 

In this case, steroids can enhance the effects of local anesthetics. This is important since it allows doctors to use a lower dosage of local anesthetics, preventing overdosing. The steroid commonly used for nerve block injections is dexamethasone.

How Long Does A Cervical Plexus Nerve Block Last?

Each person responds differently to cervical plexus nerve blocks. You may have instant pain relief lasting from a few days to weeks. Sometimes, you may also need multiple injections to achieve pain relief.

The local anesthetic can give instant pain relief; however, its effects only last for a short time and can wear off within hours. If your nerve block includes a steroid drug, you may gradually experience pain relief. This is because steroids can ease inflammation and may help your nerves heal. The effects of steroid drugs can last for days to weeks.

According to a study, cervical plexus blocks can relieve chronic neck pain for up to 14 to 16 weeks per treatment and may even last up to 46 to 48 weeks (that’s 11 months!).

How Often Can You Have A Nerve Block Injection?

The number of nerve block injections depends on your condition and response to the drugs. However, doctors usually limit the number of injections to three per year. According to one study, you can have up to 3 or 4 nerve block injections per year if you suffer from chronic neck pain.

Giving more than 3 to 4 injections per year may increase your chances of having complications due to the drugs.

What are the Risks of a Nerve Block?

A nerve block can come with its own set of risks and complications.

However, these risks have become extremely rare with imaging techniques and proper training.

But it is still essential for you to be aware of these possible complications:

• Infection
  • Since doctors make sure that the procedure is sterile, there is a low risk of acquiring infection. However, it is not impossible, and any infection is always serious. Some infections that may result from an unsterilized nerve block include meningitis and abscesses.
    

• Phrenic Nerve Block
  • Remember the diaphragm, the muscle involved in your breathing? Well, it is supplied by the phrenic nerve and part of the deep cervical plexus. Sometimes a deep cervical plexus block may result in a phrenic nerve block. This can cause paralysis of your diaphragm, making it difficult for you to breathe.
    

• Local Anesthetic Toxicity
  • Toxicity or overdose of local anesthetics is usually due to the injection of the drug into a vein or artery. Your brain has a rich supply of veins and arteries, so injecting local anesthetics into these blood vessels can be very dangerous. It may cause loss of consciousness, seizures, and even a coma.
    

• Nerve Injury
  • Sometimes the procedure may also damage or irritate your other nerves. This can result in even more severe pain.

What Are The Side Effects of Nerve Block Injections?

You may experience numbness or weakness in the blocked area, lasting up to 24 hours. During this time, you won’t be able to feel any pain, so you have to be careful not to handle objects that are too hot or too cold. You also have to be mindful of your surroundings and actions, or else you might end up going back to the hospital for a more serious injury.

Other side effects include:

• Rash
• Itching
• Soreness at the site of injection
• Bleeding or bruising at the site of injection
• Elevated blood sugar levels and weight gain due to corticosteroids
• Allergic reaction to local anesthetics.

Takeaway

A pain block, or nerve block, is a medical procedure that involves injecting drugs into a target nerve or group of nerves. When nerve blocks are used to treat neck pain, they are called cervical plexus blocks.

Nerve blocks can be used to treat chronic pain or to prevent pain after surgical procedures. They may also be used to identify the nerve responsible for your pain.

Although it is considered a safe procedure with few complications, the possible risks can be severe. However, doctors have medical devices and proper training to help prevent these complications.

If you found this article helpful, feel free to share it with friends and family. And if you had any experience with nerve blocks for your neck pain, feel free to share your story in the comments section below!