Most procedures
involve the use of a local anesthetic (numbing medicine), a steroid
(antiinflammatory medicine), and sedation (medicine to make you feel relaxed). This
sedation may affect your memory, not allowing you to remember the procedure, or
the instructions that we give you after your procedure. Because of this, your
Doctor may want to avoid verbally providing you with important information
after the procedure, since you may not remember. The Doctor will be more than
happy to go over the information upon your return.
The local
anesthetics may cause temporary numbness
and weakness of the legs or arms, depending on the location of the block.
This numbness/weakness may last 4-6 hours (the duration of the local
anesthetic) (In rare instances, it has been seen to last up to 24 hours).
During this period of numbness, you must be more careful than usual, to prevent
any injuries to the extremity.
In summery, you should expect for your pain to get better
within 15-20 minutes after the procedure. This relief or numbness is temporary
and should last 4-6 hours, after which, it will wear off. Once it wears off, you
may experience more pain than usual for up to 10 (ten) days after your
procedure. In the case of certain procedures, such as radiofrequency, you
should expect more pain than usual for 5 to 6 weeks after the procedure. IDET
and implants may take up to 8-10 weeks for the healing process. This discomfort
is due to the procedure itself (needles going through skin, muscle, and
irritation from bleeding and hematomas). To minimize the discomfort and
swelling, we recommend that you apply ice to the area where the needles went
in. Keep the ice in place for 15 minutes and then take it off and allow it to
rest for another 15 minutes. Keep repeating this cycle the rest of the day of
your procedure. We recommend filling a plastic sandwich bag with ice and
wrapping it on a towel to prevent frostbite.
Starting the next
day, you should switch to heat (moist or dry, it does not matter). Heat therapy
should continue until the pain improves (4-6 days). Be careful not to burn
yourself.
Occasionally you
will also experience muscle spasms and cramps. These occur as a consequence
of the irritation caused by the needle sticks to the muscle and the blood that
will inevitably be lost into the surrounding muscle tissue. Blood tends to be
very irritating to tissues, which tend to react by going into spasm. These
spasms may start the same day of your procedure, but they may also take days to
develop. This late onset type of spasm or cramp is usually caused by
electrolyte imbalances triggered by the steroids, at the level of the kidney.
Cramps and spasms tent to respond well to muscle relaxants, taking
multivitamins (some are triggered by the procedure, but may have their origins
in vitamin deficiencies), and taking sports drinks like Gatorade, which may
help correct these electrolyte imbalances. (Be careful if you area a diabetic,
since they contain sugar.) Warm showers or baths may be extremely helpful in
controlling the acute phase. Stretching exercises are also highly recommended.
Be alert for signs of possible infection: redness, swelling, heat, red streaks, elevated temperature, and/or fever. Please notify your doctor immediately if you have unusual bleeding, trouble breathing, or loss of the ability to control your bowel or bladder. Do not increase your pain medicine, unless instructed by your pain physician.
You will want to
be careful in moving about. Muscle spasms in the area of the injection may
occur. Use ice or heat to the area is often helpful. Occasionally, a spinal
headache may develop. (Only if you had a spinal or epidural block.) This is
different from a normal headache in the sense that it will not go away on its
own, despite normal measures. If you develop a headache that does not seem to
respond to conservative therapy, please let your physician know. This can be
treated with an epidural blood patch.
You may
experience some numbness or redness, however it should be short lived. If
persistent numbness occurs, contact your physician. (Persistent numbness would be
defined as lasting more than 4-6 hours.)
If you have had sedation, you may experience some
nausea. In this case, it may be wise to wait at least two hours prior to resuming
regular diet. If you had a “Stellate Ganglion Block” for upper extremity “Reflex
Sympathetic Dystrophy”, do not eat or drink until your hoarseness goes away. In
any case, always start with liquids first and if you tolerate them well, then
slowly progress to more solid foods.
For the first 24 hours after the procedure, do not
drive a motor vehicle, operate heavy machinery, power tools, or handle any
weapons. Consider walking accompanied by an adult for the next 24 hours. Do not
drink alcoholic beverages, including beer. Do not make any important decisions
or sign any legal documents. Go home and rest today. Tomorrow you may resume
activities as tolerated. Use caution in moving about as you may experience
weakness. Use caution in cooking, using household electrical appliances, and
climbing steps.
Monday-Thursday 8:00 am - 4:00 PM (336)-538-7180
Fridays 8:00 am - 12:00 noon (336)-538-7180
After clinic hours, have operator reach the
Doctor (336)-538-7000
In case of
emergency, go to the nearest emergency room and have the physician there call
the above number.
Interpretation of Blocks
Unrealistic expectations are the most common causes of a “perception
of failure” after a procedure. Most nerve blocks are done for diagnostic
purposes as well as for treatment. We all hope that a single nerve block will
be able to take our pain away and allow us to go back to our normal lives.
Although this is occasionally true, it is not the rule, but the exception.
Most nerve blocks are performed with local anesthetics as well as steroids.
If you are to get any long-term benefits, this will occur as a consequence of
the steroids. The purpose of steroids is to decrease any chronic
swelling that may exist in the area. They normally begin to work immediately
after being injected. Nevertheless, in most patients, it will take 5 to 10 days
for the swelling to come down to the point where you will be able to tell a
difference. Steroids will only help if there is swelling to be treated.
If the problem is one of mechanical compression, you will get no benefit
from those steroids. As such, the steroids have a diagnostic purpose, where if
effective, they suggest an inflammatory component to the pain, and if
ineffective, they rule out inflammation as the main cause or component of the
problem. This is usually referred to as the “long-term benefit” of the
procedure.
In the case of local anesthetics, their goal is not only to
provide you with some relief of the pain during and after the procedure, but
they also have a crucial role in the diagnosis of your condition. There are
short-acting (1-2 hours) and long-acting (4-6 hours) local anesthetics. Most
will begin to work within15 to 20 minutes after injected. The duration will
depend on the type used (short- vs. Long-acting). It is of outmost importance
that patients and their family members keep tract of whether there was
immediate relief of the pain after the procedure, and for how long. The local
anesthetics are essential in providing diagnostic information to the physician.
Normally, if the patient does not obtain any relief of the pain for the
duration of the local anesthetic, this would suggest that the blocked nerve was
not responsible for the conduction of the painful stimulus. On the other hand,
good relief of the pain during the time that the numbing medicine is in effect
would be interpreted as a success in having identified the nerve that is
transmitting the painful impulse, even if the pain returns when the local
anesthetic wears off. This is usually referred to as the “short-term
benefit” of the procedure.
It is therefore possible to get 100%
short-term relief of the pain, with 0% long-term relief. This would suggest
that even though the correct structure was blocked, the mechanism of the pain
does not involve an inflammatory component and therefore a different technique
will need to be applied to obtain longer lasting relief of the pain.
The above is only true if all blocks have
been performed under radiological guidance, where confirmation of needle
placement can be assessed. Otherwise, 0% short-term benefits from the procedure
may be as a consequence of a missed target.
Sadly, this information is not always given
to the patients, and even worse, in the case of diagnostic procedures performed
by “Non-Pain Specialists”, the patients are not followed after the procedure to
collect these results. The obvious problem being that a patient may not obtain
long-term benefit from the nerve block, and because of this, he/she may wrongly
assume that it was a failure. Every nerve block, whether it provides you
with relief or not, will always provide a good Pain Physician with
invaluable information that can be used to ultimately find the missing piece to
the puzzle.
Based on the above provided information, your
physician will want to know a couple of things:
1.
Did you obtain
any “short-term” relief of the pain? (Meaning:
for the initial 4 to 6 hours after the procedure.)
2.
If so, how much
relief did you get during that time? (All
of the pain went away = 100% relief. Half of it went away = 50% relief. No
relief = 0%)
3.
Did you obtain
any “long-term” relief of the pain? (Meaning:
after the local anesthetic wore off.)
4.
If so, how much
relief did you get and for how long? (All
of the pain went away = 100% relief. Half of it went away = 50% relief. No
relief = 0%)
When reporting the level of pain, please use a pain
scale from 0 to 10.
Pain is a subjective complaint. It cannot be seen,
touched, or measured. We depend solely on the patient’s account of the pain in
order to keep track of it. Since everybody tolerates different degrees of pain,
the best basis of comparison is the patient itself. To achieve this, we use a pain
scale called NAS-11 (Numeric
Analog Scale from 0 to 10 [11
characters]), where “0 = No Pain”, and “10 = the worst possible pain that you
can even imagine” (i.e. something like been eaten alive by a shark). You
will be asked to rate your pain on every visit, as well as multiple times
before and after a procedure. Please be as accurate as possible, remember that
medical decisions will be based on your responses. Please do not try to
emphasize your pain by giving us a number above the upper limits of the scale (i.e.
ì15î). This will actually be interpreted as “symptom magnification” (exaggeration),
as well as lack of understanding with regards to the scale. To put this into
perspective, when you tell us that your pain is at a 10 (ten), you are
essentially saying that you are at a level of pain where there is nothing
else that anybody can do to inflict any more pain on you. (Carefully
think about that.)