From the Guidelines
Therapeutic nerve blocks work well for the treatment of acute pain following surgery or trauma but not chronic pain. Nerve blocks involve injecting local anesthetics like lidocaine, bupivacaine, or ropivacaine near specific nerves to temporarily interrupt pain signals. These blocks are particularly effective for managing acute pain because they provide immediate, targeted relief during the initial recovery period after surgery or trauma, typically lasting 12-24 hours depending on the medication used. For surgical procedures, blocks can be administered pre-operatively or post-operatively, often as part of multimodal analgesia. The use of paravertebral blocks, for example, has been shown to reduce postoperative pain scores, analgesia consumption, and the incidence of postoperative nausea and vomiting, as demonstrated in a systematic review and procedure-specific postoperative pain management recommendations for oncological breast surgery 1. Similarly, the pectoral nerves block has been found to reduce intra-operative opioid requirements, postoperative pain scores, and opioid consumption 1. While nerve blocks can occasionally be used in chronic pain management, they generally don't address the complex neurological changes, central sensitization, and psychological factors that characterize chronic pain conditions. Chronic pain typically requires comprehensive approaches including medication management, physical therapy, psychological interventions, and sometimes neuromodulation techniques rather than temporary nerve blocks. The effectiveness of nerve blocks for acute pain stems from their ability to directly interrupt nociceptive signals before central sensitization develops, whereas in chronic pain, these pathways have already undergone significant changes that simple signal interruption cannot adequately address. In chronic pain conditions such as neuropathic pain, fibromyalgia, low back pain, and osteoarthritis, other treatments like antidepressants, anticonvulsants, and physical therapy are often more effective 1.
From the Research
Therapeutic Nerve Blocks for Pain Management
Therapeutic nerve blocks are a treatment option for various types of pain. The effectiveness of these blocks depends on the type of pain being treated.
- Therapeutic nerve blocks work well for the treatment of chronic pain but not acute pain following surgery or trauma 2, 3.
Limitations of Therapeutic Nerve Blocks
While therapeutic nerve blocks can be effective for chronic pain, they have limitations.
- They are often less effective in patients with acute pain 3.
- The effectiveness of therapeutic nerve blocks also depends on the underlying cause of the pain and the presence of psychologic or behavioral disorders 3.
Importance of Patient Selection
Patient selection is crucial when considering therapeutic nerve blocks.
- Candidates for therapeutic nerve blocks should be carefully screened to determine the best treatment approach 3.