From the Research
For nonradicular midline back pain from chronic compression fracture, a medial branch block is generally more likely to help than an epidural injection. Medial branch blocks target the facet joints, which often become the primary pain generators in chronic compression fractures due to altered biomechanics and increased stress on these joints following the vertebral collapse, as suggested by a study published in the journal Pain Physician 1. The procedure involves injecting local anesthetic around the medial branch nerves that supply sensation to the facet joints. If the initial diagnostic block provides significant pain relief (usually >50%), therapeutic blocks with longer-acting anesthetics or radiofrequency ablation may provide more sustained relief.
Some key points to consider when deciding between a medial branch block and an epidural injection include:
- The mechanism of pain generation: nonradicular midline pain from compression fractures is less likely to respond to epidural injections, which primarily target radicular pain from nerve compression or inflammation 2.
- The role of facet joints in chronic compression fractures: the posterior elements, including the facet joints, may play a significant role in the pain generated after vertebral compression fractures, making medial branch blocks a potentially effective treatment option 2.
- The importance of a comprehensive treatment approach: both medial branch blocks and epidural injections should be considered part of a broader treatment plan that includes physical therapy, appropriate analgesics, and possibly bracing to stabilize the spine 3, 4, 5.
In terms of specific treatment options, a study published in the journal Current Opinion in Anaesthesiology found that medial branch radiofrequency ablation or facet injections may be an effective tool in providing analgesia in patients with pain after vertebral compression fractures 2. Additionally, a study published in the Australian Journal of General Practice suggested that tapentadol may be a safe and effective medication for treating severe low back pain, including nonradicular midline back pain from chronic compression fracture 5.
Overall, the choice between a medial branch block and an epidural injection should be based on a thorough evaluation of the patient's condition and a consideration of the potential benefits and risks of each treatment option, with a focus on improving morbidity, mortality, and quality of life outcomes.