# Peripheral Nerve Block
A nerve block is a medical procedure designed to treat chronic pain and neuropathic pain. It can be given for pain in the facial, jaw, and head areas, and is performed through precise injection of anesthetic agents to specific nerve areas causing the pain.
Anatomy of Facial and Head Pain The facial and head area receives its sensation from two main sources:
Trigeminal Nerve: The trigeminal nerve exits from the brain and divides into three main branches:
- Upper branch - provides sensation to the forehead and upper eyelid area
- Middle branch - covers the cheek area, upper lip, and upper gums
- Lower branch - responsible for sensation in the lower jaw, lower lip, and chin
Together, these three branches cover almost the entire facial area and provide it with sensation.
Spinal Nerves: These nerves exit from the cervical spine and cover areas that the trigeminal nerve does not reach:
- Angle of the jaw and the area behind the ear
- The ear and the surrounding area
- The back of the head and neck
Examples:
- The temporomandibular joint area receives innervation from two branches of the trigeminal nerve
- The jaw angle area receives innervation from a combination of a brain nerve and a spinal nerve
# How is the Nerve Block Performed?
The doctor maps the pain area(s) according to the patient's report and thorough clinical examination. After this, they insert a thin, fine needle into the vicinity of the nerve(s) causing the pain. A local anesthetic solution is injected, sometimes together with a steroid medication. The substance penetrates the nerve sheath and stops the transmission of pain signals.
# When is Treatment Recommended?
# Nerve block is recommended in the following cases:
- Neuropathic pain - pain arising from damage or dysfunction of the nerves themselves
- Chronic pain that reflects chronic processes causing disruption in pain sensation and processing, and does not respond to conservative treatments
- Patients who cannot or do not wish to take neurological medications for extended periods
- Precise diagnosis of pain source - the treatment helps identify which nerve is responsible for the pain
# Specific Cases Suitable for Nerve Block Treatment:
- Chronic nociceptive pain with peripheral sensitization (such as chronic TMJ inflammation, chronic muscle pain, etc.)
- Trigeminal or occipital neuralgia
- Post-herpetic neuralgia
- Post-traumatic neuropathy (nerve damage following surgery or local trauma)
# How Does the Treatment Feel?
- The procedure is usually performed under local anesthesia. For people with anxiety, light sedation can be considered
- The procedure is considered relatively safe
- The anesthetic effect wears off after several hours
- Pain relief usually lasts much longer
# Treatment Frequency
In many cases, there is a need to repeat the treatment:
- Frequency: Once every few weeks
- Goal: Enhancing the anti-pain effect
- The patient's response to the first treatment helps plan future treatments
# Combined Treatment
Sometimes pain arises from multiple factors simultaneously:
- Cartilage wear in the TMJ combined with chronic neuropathic pain
- Chronic muscle pain combined with neuropathic pain
In such cases, a combination of different types of treatments is required to achieve optimal relief.
Peripheral nerve block constitutes an effective and safe therapeutic tool for treating a wide range of chronic head, facial, and neck pain, especially when conservative treatments have not provided adequate relief.
