Nerve Blocks and Pain Pumps for Joint Pain: What You Should Know

Key Takeaways

• Nerve blocks temporarily or permanently interrupt pain signals from joints
• Used when other treatments haven’t provided adequate relief
• Can be diagnostic (to identify pain source) or therapeutic (to treat it)
• Pain pumps deliver medication directly to the spine for widespread pain
• These are typically reserved for severe, refractory pain
• Performed by pain management specialists or anesthesiologists

When standard treatments for joint pain aren’t enough, interventional procedures like nerve blocks and pain pumps offer additional options. These techniques directly target the pain pathway to provide relief.

Understanding Nerve Blocks

What Is a Nerve Block?

A nerve block involves injecting medication near specific nerves to interrupt pain signals. The injection prevents pain messages from traveling from the joint to the brain.

Types of Nerve Blocks for Joint Pain

Diagnostic blocks:

• Small amount of local anesthetic
• Temporary relief confirms pain source
• Helps plan further treatment
• Relief lasting hours indicates positive response

Therapeutic blocks:

• Local anesthetic plus steroid
• Longer-lasting relief
• May need to be repeated
• Bridges to other treatments

Neurolytic blocks:

• Permanently damage the nerve (chemical or heat)
• Reserved for severe, refractory cases
• More permanent effect
• Not reversible

Common Nerve Block Locations

Genicular nerve block (knee):

• Targets nerves around the knee
• Multiple injection sites
• Good for knee OA
• Can lead to radiofrequency ablation

Lateral femoral cutaneous block (hip):

• Targets nerve to outer thigh
• May help some hip pain
• Limited to specific pain patterns

Suprascapular nerve block (shoulder):

• Targets main sensory nerve to shoulder
• Helps shoulder OA and other conditions
• Well-established technique

Facet joint blocks (spine):

• Targets small joints between vertebrae
• For neck or low back pain
• Diagnostic and therapeutic

How Nerve Blocks Are Done

Before the Procedure

Preparation:

• Review of medications (may hold blood thinners)
• Imaging review
• Discussion of expectations
• Consent process

Day of procedure:

• May have light sedation option
• Area cleaned and prepared
• Monitoring equipment attached
• Local anesthetic to skin

During the Procedure

Typical steps:

1. Positioning for access to target
2. Fluoroscopy or ultrasound guidance
3. Local anesthetic to skin
4. Needle advanced to target nerve
5. Contrast dye confirms position (sometimes)
6. Medication injected
7. Needle removed

Duration: 15-45 minutes typically

After the Procedure

Immediately:

• Brief observation
• Assessment of response
• May feel numbness in target area
• Discharge home same day

First 24-48 hours:

• Some soreness at injection site
• Watch for signs of problems
• Note degree of pain relief
• May keep pain diary

Genicular Nerve Block and Radiofrequency Ablation

Why the Knee Is Special

The knee has been the focus of significant nerve block research:

• Genicular nerves are well-defined
• Accessible with image guidance
• Good results in studies
• Can progress to ablation if blocks help

Diagnostic Block First

The protocol:

1. Diagnostic block with local anesthetic only
2. If 50%+ pain relief → proceed to ablation
3. If minimal relief → consider other options

Radiofrequency Ablation (RFA)

How it works:

• Heat is applied to the nerve
• Creates a lesion that disrupts pain signaling
• Effect lasts months to over a year
• Nerve may regenerate (repeat procedure possible)

What research shows:

• Multiple studies support efficacy for knee OA
• 60-80% of appropriate patients get significant relief
• Duration typically 6-12+ months
• May delay or avoid knee replacement for some

Pain Pumps (Intrathecal Drug Delivery)

What Is a Pain Pump?

A pain pump is a surgically implanted device that delivers pain medication directly to the fluid around the spinal cord. This allows much smaller doses than oral medication while providing strong pain relief.

How It Works

Components:

• Pump reservoir (implanted in abdomen)
• Catheter (thin tube to spinal fluid)
• Programmer (external device to adjust settings)

Medication delivery:

• Constant or variable rate
• Medications: Morphine, ziconotide, baclofen, others
• Refilled every 1-6 months
• Doses adjusted as needed

Who Is a Candidate?

Typical criteria:

• Severe, chronic pain
• Failed other treatments
• Successful trial of intrathecal medication
• Life expectancy of several years
• Able to manage refill appointments
• No active infection or bleeding disorder
• Psychologically appropriate

Common indications:

• Failed back surgery syndrome
• Complex regional pain syndrome
• Cancer pain
• Severe, widespread arthritis pain (less common)

The Trial Period

Before permanent implantation:

1. Trial injection or temporary catheter
2. Evaluate pain relief
3. Assess side effects
4. Make informed decision about permanent pump

Risks and Complications

Nerve Block Risks

Common:

• Temporary increased pain
• Bruising
• Soreness at injection site

Less common:

• Infection
• Nerve damage (usually temporary)
• Bleeding
• Allergic reaction

Rare:

• Spinal headache (with certain blocks)
• Significant nerve injury

Pain Pump Risks

Device-related:

• Infection (requires removal)
• Catheter problems (migration, kink, break)
• Pump malfunction
• Need for surgical revision

Medication-related:

• Side effects of medications
• Tolerance (need for dose increases)
• Withdrawal if pump fails

Long-term:

• Scar tissue around catheter tip
• Ongoing maintenance requirements
• Battery replacement surgery (~7 years)

Finding a Provider

Who Performs These Procedures?

• Pain management physicians
• Anesthesiologists with pain fellowship
• Physiatrists (PM&R doctors)
• Some neurologists

Questions to Ask

1. How many of these procedures have you done?
2. What outcomes do your patients typically experience?
3. What are the risks specific to my situation?
4. What happens if it doesn’t work?
5. How many follow-up visits are needed?

Red Flags

Be cautious if:

• Pressure to proceed quickly
• Won’t discuss risks
• No imaging guidance used
• Doesn’t do diagnostic blocks first
• Excessive number of procedures recommended

Cost and Insurance

Typical Costs

Procedure	Price Range
Diagnostic nerve block	$500-$2,000
Therapeutic nerve block	$500-$2,500
Radiofrequency ablation	$2,000-$5,000
Pain pump trial	$3,000-$8,000
Pain pump implantation	$15,000-$50,000

Insurance Coverage

Usually covered with documentation:

• Nerve blocks for documented chronic pain
• Failed conservative treatment documented
• Prior authorization often required
• Specific criteria must be met

For pain pumps:

• Strict criteria for approval
• Successful trial required
• Significant documentation needed
• May require peer-to-peer review

Making the Decision

When to Consider Interventional Options

Appropriate situations:

• Significant pain despite other treatments
• Pain limiting quality of life
• Unable to function in daily activities
• Trying to avoid or delay surgery
• Not a candidate for surgery

Questions to Ask Yourself

1. Have I truly maximized other treatments?
2. Am I prepared for a procedure that may not work?
3. Can I commit to follow-up and repeat procedures?
4. Are my expectations realistic?
5. Do I understand all the alternatives?

Frequently Asked Questions

How long does a nerve block last?

A diagnostic block with local anesthetic only lasts hours. Therapeutic blocks with steroid may last weeks to months. Radiofrequency ablation typically lasts 6-12+ months, though it varies by individual. Nerves can regenerate, so effects may diminish over time.

Are nerve blocks painful?

There’s brief discomfort from needle insertion despite local anesthetic. The procedure itself usually isn’t severely painful. Most people tolerate it well. Sedation is available if you’re anxious. Post-procedure soreness is common but temporary.

Can nerve blocks damage nerves?

There’s a small risk of nerve injury, usually temporary. With proper technique and imaging guidance, serious nerve damage is rare. The benefit-to-risk ratio is generally favorable for appropriate candidates. Discuss specific risks with your doctor.

Why doesn’t everyone with severe pain get a pain pump?

Pain pumps are reserved for severe, refractory cases because they’re surgically implanted, require ongoing maintenance, and have significant risks and costs. Most people can be managed with less invasive options. Pumps are appropriate only when other treatments have failed.

Will nerve blocks help me avoid joint replacement?

Possibly. For some patients, procedures like genicular nerve ablation provide enough relief to delay or avoid knee replacement. However, they don’t fix the underlying arthritis. If your joint deteriorates significantly, surgery may eventually be needed regardless.

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Exploring treatment options? Learn about steroid injections or read about when joint replacement becomes necessary.

Last medically reviewed: January 2025

Medical Disclaimer: This article is for informational purposes only. Interventional pain procedures carry risks and should be discussed thoroughly with a qualified pain management specialist who can evaluate your specific situation.