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Upper back – Thoracic Medial Branch Blocks

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What are Thoracic facet joints?

Facet joints (also called zygapophyseal joints) are small joints of the spine that provide stability and help guide motion. They are found in the neck (thoracic), upper back (thoracic) and lower back (thoracic). They can become painful as a result of arthritis, injury or mechanical stress. Two nerves called “medial branches” supply each facet joint. These nerves carry pain signals to the spinal cord and these signals will eventually reach the brain. The proportion of patients who are affected by facet related pain increased with age and can be as high as 45% in patient population with spinal pain.

What is a Thoracic Medial Branch Block procedure?

 

The facet joints and/or Thoracic medial branch nerves can be injected with a local anaesthetic and/or steroid.

There are two reasons for doing this:

  1. Diagnosis:If the local anaesthetic in the injection relieves your pain then it suggests that the Thoracic facet joints are a source of your pain. Repeating the procedure, a second time improves accuracy of the diagnosis. This can guide future treatment such as “radio frequency lesioning” of Thoracic medial branch nerves. There is strong scientific evidence to support this.

Therapy:The steroid in the injection can reduce inflammation, reduce Thoracic medial branch nerve sensitivity and provide long lasting pain relief. The duration of pain relief may h blocks are diagnostic injections utilized to assess the contribution of the facet joints to the patient’s spinal pain.

What happens during the procedure?

The procedure is performed in the operation theatre. You will be sedated and local anaesthesia will be used to numb your skin. The doctor will then insert a small needle near the Thoracic medial branch nerve. Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle. Once the doctor is sure the needle is correctly placed, the medicine is injected.

biopsy

Diagnostic Injections

heart-rate

Pulsed Radio Frequency

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Radio Frequency

brain

Neuromodulation

painmed

Regenerative Therapy

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Cancer Related Procedures

What happens after the procedure?

You will be monitored for up to monitored closely in the recovery room for 30 minutes after the injection. When you are ready to leave, the staff will give you discharge instructions. You will need to keep a pain diary. It is important to maintain a diary to help the doctor ascertain the success of the diagnostic injection. You may feel immediate pain relief and numbness in your back for a limited period of time after the injection which is the local anaesthetic effect and an indication that the right areas were targeted.

How long can I expect pain relief?

The Thoracic medial branch block is a diagnostic procedure like any other medical imaging modality e.g. X-ray, MRI scans. The expectation is that you have short-term good quality pain reduction. If that is the case you maybe a suitable candidate for radiofrequency ablation (RFA) of the thoracic medial branch nerve. This procedure provides a more sustained disruption of pain signals and often prolonged pain relief.

How do I prepare for the procedure?

Please advise staff if you are:

  1. Taking blood thinners (especially warfarin and clopidogrel)
  2. Diabetic
  3. Pregnant (or any chance of you being pregnant).
  4. Allergic to iodine, betadine, shellfish, local anaesthetics, or steroids.
  5. Unwell (especially if you have an infection)

 

Staff may advise you to:

  1. Fast
  2. Take your usual medications (apart from those mentioned above)
  3. Arrange for someone to accompany you home

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    Dr. Sally Wride

    Originally from England, Sally graduated from St George’s Hospital, University of London in 2004 with a BSc (First Class Hons) in Physiotherapy. Since settling in Australia, Sally has worked in private practice and in the public hospital setting across Sydney.

    Sally gained a Masters in Medicine Pain Management from the University of Sydney in 2019 and is a Titled Pain Physiotherapist (as awarded by the Australian Physiotherapy Association).

    In addition to private practice, Sally currently works as a Senior Physiotherapist at Westmead Hospital Pain Management Service.

    Sally is highly skilled in assessing, diagnosing and treating people who experience chronic pain. She enjoys working with injured workers and CTP claimants. She has a deep understanding of the impact of pain on the whole person and on their functioning in daily life. In partnership with her colleagues, Sally enjoys applying her knowledge and clinical skills to provide a safe space for exploration of the physical and emotional meaning of pain and for recovery of function.

    Qualifications and Experience

    Education
    • BSc Hons Physiotherapy (St George Hospital University of London)
    • BA Hons Sports Studies (Brunel University London)
    • MSc in Medicine Pain Management (Sydney University)
    MSc in Medicine Pain Management (Sydney University) Accreditations
    • Titled Pain Physiotherapist (as awarded by Australian Physiotherapy Association
    • Member of the Australian Physiotherapy Association
    • Health Professional Councils Authority Registration

    Dr. Baraa Kassim

    Dr. Baraa Kassim is a highly skilled rehabilitation and pain management specialist. With experience in treating patients with complex medical conditions, her expertise spans strokes, neurological, orthopedic, musculoskeletal, and geriatric conditions, as well as spasticity management and spinal and brain injury rehabilitation.

    Dr. Adam Mir

    Dr. Adam is a Fellowship-trained Pain Medicine Specialist with a Fellowship from the Faculty of Pain Medicine (FFPMANZCA) and a Master of Pain Medicine from the University of Sydney. He is dedicated to the comprehensive management of chronic pain across all age groups.

    Dr. Adam trained in adult pain medicine at Liverpool Hospital, Nepean Hospital, and the Department of Pain Medicine, and completed additional training in paediatric chronic pain at The Children’s Hospital at Westmead. He currently serves as a Staff Specialist at Westmead and St George Public Hospitals (NSW Health), and is a Visiting Medical Officer (VMO) at Liverpool Public Hospital, St George Private, Sydney Southwest Private, Holroyd Private, Norwest Private, and Nepean Private Hospitals.

    He adopts a whole-person, multidisciplinary approach rooted in the socio-psycho-biomedical model, utilising both pharmacologic and interventional techniques. These include:

    • Nerve blocks
    • Radiofrequency neurotomy
    • Platelet-Rich Plasma (PRP) therapy
    • Spinal cord stimulation
    • Extra Corporal Shockwave Therapy (ECSWT)

    Dr. Adam is an Authorised Prescriber of Medicinal Cannabis and holds a Diploma in Medicinal Cannabis. He is also certified in Opioid Treatment Programs, including Methadone, Suboxone, and Buprenorphine injections. His areas of interest include opioid dependence management, medicinal cannabis, and interventional pain procedures.

    He also completed advanced training in Virtual Reality Therapy for chronic pain and mental health disorders in Barcelona, Spain, and has further qualifications in Focused Psychological Strategies, Cognitive Behavioural Therapy (CBT), and Clinical Hypnosis.

    Qualifications:

    • FFPMANZCA: Fellowship, Faculty of Pain Medicine, ANZCA
    • MMed (Pain Medicine): University of Sydney
    • MD: Medical Doctor
    • Diploma in Child Health: The Children’s Hospital at Westmead
    • Diploma in Medicinal Cannabis: Authorised Prescriber
    • Certificate in Opioid Treatment (Methadone/Suboxone): Australian Chapter of Addiction Medicine
    • Certification in ECSWT: Extra Corporal Shockwave Therapy
    • Focused Psychological Skills (FPS), CBT: Australian Society for Psychological Medicine
    • Clinical Hypnosis: The College of Medical Hypnosis
    • Clinical Hypnosis: The College of Medical Hypnosis
    Languages Spoken: English, Persian (Farsi), Dari

    Dr. Alister Ramachandran

    Dr. Alister Ramachandran, a dual specialist in Anaesthesia and Pain Medicine, boasts 20+ years of experience. FIPP-certified, he leads Westmead’s pain service, teaches at Sydney University, and is a Faculty of Pain Medicine examiner. His focus remains on delivering evidence-based chronic pain treatment, ensuring comprehensive and effective pain management intervention.