Prolonged pain relief after MBB

[deleted185747]

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Does a prolonged duration of pain relief after a diagnostic MBB with local anesthetic only predict response to RFA? I have had a few patients who experience a month or more of significant pain relief from a MBB. Any ideas on what this says as the source of pain? Does this make you think it’s the facet or the muscles? What’s the difference in outcome from RFA?

 

[voodoomedic]

I see this in about 1 in 10-15 patients, and from speaking to colleagues, it's perhaps attributed to breaking a feedback loop in the pain-generating nerves, like hitting ctrl+alt+del on the laptop; stop the cycle temporarily and they get relief until the facet disease process flares up again

 

[painfree23]

Don’t RF until pain returns.

 

[SommeRiver]

I get this ONLY in pts over 65, and it happens frequently, but usually a week or two. I've had a few MBB prevent RFA too.

I tell pts I'm breaking up a pain pathway that may not immediately cycle back up to previous levels.

I never see this in pts under mid 60s.

 

[SSdoc33]

Exactly. Only in the old Codgers. But, these folks get great relief with RF. Basically, mbb works really well because they have exclusively facetogenic pain

 

[DrSpine]

I have a really older clientele and I see this all the time. The MBB sometimes will last them 4 days on average. I typically RF it after the pain comes back. If they're ever feeling solid, I'll hold off. What's the point of impressing them with my technical skills just to do so? lol

 

[Ducttape]

I remember hearing someone (?Bogduk) say to expect a significant 10-15% to have 2-3 months relief of pain.

otoh, one study I saw used that effect - prolonged pain relief - as a marker of placebo effect.

 

[Baron Samedi]

Fluoro-guided trigger point injection

 

[Aether2000]

I had an elderly lady come back two years later for a repeat spine intervention procedure that had provided relief for 2 years. I couldn't find the RF note, and asked her where did we do the RF? She responded she had only that one injection (MBB) and wanted me to repeat it. It was a lumbar MBB. It is probable that my 22ga needle (what I was using at the time) actually severed the medial branch.