Nerve Blocks

Nerve Blocks

How Common Is This Procedure?

Based on Marketdata's last major study of pain management programs, 82% of all pain treatment practitioners used nerve blocks to treat chronic pain. This share was exceeded only by trigger point injections at 84%. And, 100% of anesthesiologists use nerve blocks.

It's ironic that nerve blocks are also the second most often denied procedure by insurers.

Some anesthesiologists spend little time on patient evaluations, concentrating mostly on performing nerve block procedures. At the high-volume end, the doctor may see 15-20 patients a day, several times per week. At the low-volume end of the scale, an anesthesiologist may see 3-5 patients a day. Most workweeks average 2-5 days. A typical epidural nerve block for lower back pain costs $350-400 for several visits. Costs vary, depending on the site of the block. Some patients only come for 3-4 visits, while others may be treated for 1-2 years, and some do not respond to treatment at all.

The Cost

In 2003, The average cost derived from respondents PER VISIT by anesthesiologists was $378.77. At an average of 9.7 visits during a patient’s treatment, this came to a total treatment tab of $3,674. By comparison, the average cost in 2001 was $4,504.

This is about 25% lower than the total pain programs group average, and is about 34% lower than the cost of multidisciplinary pain management programs ($5,547 in 2003). The per-visit charge for multidisciplinary programs, based on Marketdata's last survey ($571.94) is 50% higher than treatment by an anesthesiologist.

How Nerve Blocks Are Done

To do a nerve block, the physician will inject an anesthetic around a nerve's fibers. This prevents pain messages that are traveling along that nerve pathway from reaching the brain. Nerve blocks are most often used to relieve pain for a short period, such as during surgery. If there is inflammation around a nerve, an injection of corticosteroid in conjunction with the nerve block may provide longer pain relief.

Types of Nerve Blocks

There are three main types of nerve blocks:

·     Peripheral. For localized pain, an anesthetic is injected around a nerve that's away from the spine, such as in an ankle. The result is reduced feeling and less pain in that area.

·     Spinal. For pain that affects a broader area, such as your lower back or a leg, an anesthetic is injected in or near the spinal column. An injection directly into the spinal fluid is called an intrathecal injection. This type of injection is often used during surgery on the abdomen or legs.

·     If the injection isn't into the spinal fluid, it's called an epidural injection. Epidurals are often used to relieve the pain of childbirth and sometimes to relieve some types of back pain, such as sciatica.

Various areas of pain require different nerve block types. Below are a few of the available nerve blocks, followed in parentheses by some of the parts of the body for which they are used.

Trigeminal nerve blocks (face)
Ophthalmic nerve block (eyelids and scalp)
Supraorbital nerve block (forehead)
Maxillary nerve block (upper jaw)
Sphenopalatine nerve block (nose and palate)
Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
Cervical plexus block and cervical paravertebral block (shoulder and upper neck)
Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand, elbow, and wrist)
Subarachnoid block and celiac plexus block (abdomen and pelvis)