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A nerve block is a precision, image-guided injection that interrupts pain signals from a specific nerve. The procedure serves two purposes in one visit: it confirms the source of chronic pain and, in many cases, provides weeks to months of therapeutic relief.
Nerve blocks are for adults in Houston with chronic back, neck, knee, hip, shoulder, or sacroiliac joint pain that has not improved with physical therapy, medication, or prior injections. They are also used as the diagnostic step before radiofrequency ablation, and as a non-surgical alternative for patients hoping to delay or avoid joint replacement or spinal fusion.
or call 346-217-1111 · Houston office
By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated May 2026
On This Page:
- What Is a Nerve Block?
- How Nerve Blocks Work
- Types of Nerve Blocks We Perform
- Medial Branch Block (Spine)
- Genicular Nerve Block (Knee)
- Lateral Branch Block (Sacroiliac Joint)
- Femoral and Obturator Nerve Block (Hip)
- Suprascapular and Axillary Nerve Block (Shoulder)
- Conditions That May Benefit
- The Procedure: Step by Step
- How to Prepare for Your Nerve Block
- What to Expect After
- Risks and Side Effects
- Diagnostic vs. Therapeutic Nerve Blocks
- What Happens Next: From Diagnostic Block to Long-Term Relief
- Cost and Insurance
- Nerve Block Injections at Our Houston Office
- Frequently Asked Questions
Chronic pain that has not responded to medication, physical therapy, or rest can come from many sources: the small joints of the spine, an arthritic knee, the sacroiliac joint at the base of the back, a worn hip, or a damaged shoulder. A nerve block is a targeted injection that helps identify which nerves are carrying the pain and, in many cases, provides meaningful relief at the same time. At Performance Pain and Sports Medicine in Houston, the physicians use image-guided nerve block injections to pinpoint pain generators and guide patients toward the most effective long-term treatment. Conservative, non-surgical care is exhausted first, and nerve blocks serve as a precise diagnostic and therapeutic step before more invasive options are considered.
What Is a Nerve Block?
A nerve block is an injection of local anesthetic, sometimes combined with a corticosteroid, placed near a specific nerve that carries pain signals. By temporarily numbing that nerve, the procedure interrupts pain transmission from the joint, muscle, or structure it serves.
Nerve blocks serve two related purposes. As a diagnostic tool, a block answers a clinical question: is this specific nerve the source of pain? If numbing the nerve eliminates or significantly reduces symptoms, the diagnosis is confirmed. As a therapeutic tool, the same injection (often with added anti-inflammatory medication) can provide pain relief lasting weeks to months, especially when treating joint-related or inflammatory conditions.
The Cleveland Clinic notes that nerve blocks are a common option for chronic pain that has not improved with conservative treatments, and may delay or prevent the need for more invasive procedures (Cleveland Clinic, Nerve Block Overview).
How Nerve Blocks Work
Every painful joint or structure in the body has a specific nerve supply. The medial branch nerves carry pain from the facet joints of the spine. The genicular nerves carry pain from the knee. The lateral branches of the dorsal rami carry pain from the sacroiliac joint. The femoral and obturator nerves carry pain from the hip joint capsule. The suprascapular and axillary nerves carry pain from the shoulder.
When a small volume of local anesthetic is placed next to one of these nerves, it blocks the electrical signal from reaching the brain. The patient experiences a marked reduction or complete elimination of the pain associated with that nerve.
Every nerve block at Performance Pain and Sports Medicine is performed under live X-ray (fluoroscopic) guidance. Real-time imaging confirms that the needle tip is in the correct anatomic location, which is critical for both diagnostic accuracy and patient safety.
Types of Nerve Blocks We Perform
The Houston physicians at Performance Pain and Sports Medicine perform five categories of nerve blocks, each targeting a different region of the body.
Medial Branch Block (Spine)
A medial branch block is an injection placed near the small medial branch nerves that supply the facet joints of the spine. Each facet joint receives medial branch nerves from two spinal levels, which is why the injection targets specific nerve locations rather than the joint itself.
The primary purpose is diagnostic. International consensus guidelines recognize medial branch blocks as more predictive than intra-articular injections for identifying facet joint pain and selecting candidates for longer-term treatment (Cohen et al., Reg Anesth Pain Med, 2020).
Medial branch blocks are performed at three levels:
- Lumbar (low back). Research indicates that facet joints contribute to 27 to 40 percent of chronic low back pain cases (Van Oosterwyck et al., Life, 2024). Lumbar blocks are the most common.
- Cervical (neck). Cervical facet pain may account for up to 49 percent of chronic neck pain, with false-positive rates of 25 to 63 percent on a single block (Manchikanti et al., Pain Physician, 2020). A confirmatory second block is especially important at this level.
- Thoracic (mid-back). Less common but used when persistent mid-back pain points to thoracic facet involvement.
When a medial branch block confirms facet joint pain, the next step is typically radiofrequency ablation in Houston, which can provide six months or longer of relief.
Genicular Nerve Block (Knee)
The genicular nerves are small sensory branches that carry pain signals from the knee joint capsule. A genicular nerve block targets the superior medial, superior lateral, and inferior medial genicular nerves, the three primary contributors to knee pain.
This block helps patients with chronic knee pain from osteoarthritis who have not responded to physical therapy, anti-inflammatory medication, or intra-articular injections. It is also used in patients who are not candidates for knee replacement, or who want to delay surgery.
A systematic review of randomized controlled trials and retrospective studies concluded that both genicular nerve block and genicular nerve ablation effectively reduce pain and improve function in knee osteoarthritis, with minimal and transient adverse events (Toubasi et al., Cureus, 2025). In a placebo-controlled randomized trial, ultrasound-guided genicular nerve blocks produced statistically significant reductions in pain at 2, 4, and 8 weeks compared with saline (Shanahan et al., Arthritis Rheumatol, 2022).
As with the medial branch block, a successful genicular nerve block identifies patients who are good candidates for genicular radiofrequency ablation, a longer-lasting treatment option.
Lateral Branch Block (Sacroiliac Joint)
The lateral branches of the dorsal rami carry pain from the sacroiliac (SI) joint, the joint that connects the base of the spine to the pelvis. SI joint pain accounts for 15 to 30 percent of all chronic low back pain cases, yet it is frequently overlooked or under-diagnosed (Buchanan et al., J Pain Res, 2021).
A lateral branch block is the diagnostic standard for confirming SI joint pain. The block targets the L5 dorsal ramus and the S1 through S3 lateral branches. If the block significantly reduces pain, the next step is typically radiofrequency ablation of those same lateral branches. A 2023 evidence review found that radiofrequency ablation following positive diagnostic lateral branch blocks is efficacious for SI joint pain, with cooled radiofrequency showing the strongest evidence (Szadek et al., Pain Pract, 2023).
This procedure is often combined with a separate sacroiliac joint injection in patients whose pain may have both intra-articular and extra-articular components.
Femoral and Obturator Nerve Block (Hip)
Pain from the hip joint is carried by sensory branches of the femoral and obturator nerves to the anterior hip capsule. A femoral and obturator nerve block targets these branches to relieve chronic hip pain, most commonly from advanced hip osteoarthritis.
This block is particularly useful for patients with severe hip osteoarthritis who are not surgical candidates due to medical comorbidities, who are waiting for surgery, or who want a non-surgical alternative to total hip replacement. A randomized clinical trial of 44 patients with severe hip osteoarthritis who had failed conservative treatment found that obturator nerve block produced statistically significant improvements in pain (VAS) and function (WOMAC) at one and four months, with no severe adverse events reported (Crema et al., Acta Ortop Bras, 2023).
The procedure is performed under fluoroscopic or ultrasound guidance. As with other diagnostic blocks, a positive response may indicate that the patient is a candidate for radiofrequency ablation of the hip articular nerves for longer-lasting relief.
Suprascapular and Axillary Nerve Block (Shoulder)
The suprascapular and axillary nerves provide the majority of sensation to the shoulder joint. A suprascapular and axillary nerve block targets these nerves to relieve chronic shoulder pain from rotator cuff disease, adhesive capsulitis (frozen shoulder), shoulder osteoarthritis, and post-surgical pain.
A 2025 systematic review of randomized controlled trials concluded that suprascapular nerve blocks combining local anesthetic with corticosteroid significantly reduce chronic shoulder pain at three months compared with standard non-operative care (Scattergood et al., Eur J Orthop Surg Traumatol, 2025). In a separate observational study of 71 patients with chronic shoulder pain, ultrasound-guided suprascapular nerve blockade produced pain reduction in 89.8 percent of patients at one month, with 43.7 percent achieving complete pain remission at six months (Sá Malheiro et al., Braz J Anesthesiol, 2020).
The block is often repeated as part of a treatment plan and can be combined with physical therapy to support recovery of shoulder range of motion.
Conditions That May Benefit
Nerve block injections may be recommended when imaging, physical examination, and a patient’s pain pattern point toward a specific structure as the source of symptoms. Common conditions treated by nerve type include:
- Spine (Medial Branch Block):
- Facet joint osteoarthritis (lumbar, cervical, thoracic)
- Chronic axial back or neck pain that worsens with extension or rotation
- Spondylolisthesis-related facet loading
- Persistent pain after spinal fusion
- Knee (Genicular Nerve Block):
- Knee osteoarthritis
- Chronic post-surgical knee pain after total knee replacement
- Patients who are poor surgical candidates for knee replacement
- Diagnostic step before genicular radiofrequency ablation
- Sacroiliac Joint (Lateral Branch Block):
- Sacroiliac joint dysfunction
- Pain after lumbar fusion (SI joint takes on increased load)
- Chronic low back or buttock pain that does not respond to other treatments
- Hip (Femoral and Obturator Nerve Block):
- Hip osteoarthritis
- Patients awaiting hip replacement or not eligible for surgery
- Chronic hip joint pain after fracture or surgery
- Shoulder (Suprascapular and Axillary Nerve Block):
- Rotator cuff tendinopathy and partial tears
- Adhesive capsulitis (frozen shoulder)
- Shoulder osteoarthritis
- Persistent post-surgical shoulder pain
The first step is always a careful clinical evaluation to identify the most likely pain generator before selecting the appropriate block.
The Procedure: Step by Step
Most nerve block injections take 15 to 30 minutes and are performed in an outpatient setting. Patients remain awake throughout. Sedation is available for patients who experience significant anxiety, though many patients complete the procedure comfortably without it.
- Positioning. The patient is positioned to provide the physician access to the area being treated (face down for spine and SI joint, supine for hip and knee, seated or face down for shoulder).
- Skin preparation. The skin over the injection site is cleaned with antiseptic solution and numbed with a small amount of local anesthetic.
- Image guidance. Using fluoroscopy (live X-ray), the physician advances a thin needle to the precise location of the target nerve. Contrast dye may be used to confirm correct needle placement.
- Injection. A small volume of local anesthetic (sometimes combined with corticosteroid) is injected near the nerve. Multiple levels or nerve sites may be treated during a single session.
- Observation. The patient is monitored briefly and asked to perform movements that normally provoke pain. The response is documented in a pain diary that the clinical team provides.
The anesthetic typically takes effect within minutes, and most patients leave the office within 30 minutes after the procedure.
How to Prepare for Your Nerve Block
Preparation is straightforward, but a few steps help ensure accurate diagnostic results and a smooth procedure:
- Blood thinners. The physician may advise pausing certain blood-thinning medications several days before the procedure. Instructions depend on the specific medication.
- Fasting. If sedation is planned, the patient may need to avoid eating for several hours beforehand. Patients not receiving sedation typically do not need to fast.
- Clothing. Wear loose, comfortable clothing that allows easy access to the area being treated.
- Transportation. Arrange for someone to drive home, especially if sedation is used or the lower extremity is being numbed.
- Pain diary. The clinical team provides instructions on tracking pain levels before and after the block. Accurate documentation is essential for determining whether the block was diagnostically successful.
The office staff confirms specific instructions during scheduling.
What to Expect After
Pain relief from the local anesthetic typically begins within minutes and may last several hours. With longer-acting agents such as bupivacaine, some patients experience meaningful relief for several days. When corticosteroid is added (typical for therapeutic blocks of the knee, shoulder, hip, and SI joint), relief can last weeks to months as the anti-inflammatory effect develops.
Most patients return to normal activities the same day or the following day. Mild soreness at the injection site is common and typically resolves within 24 to 48 hours.
- Tracking your response matters. The clinical team asks patients to document pain levels carefully in the hours and days following the block. For diagnostic blocks, a 50 percent or greater reduction in pain is generally considered a positive response and guides the next treatment decision. For therapeutic blocks, the goal is sustained pain relief that allows the patient to participate in physical therapy and return to daily activities.
Patients should avoid strenuous activity for the first 24 hours, then resume their normal routine as tolerated. The office schedules a follow-up to review the pain diary and discuss next steps.
Risks and Side Effects
Nerve block injections have a strong safety record. A systematic review of more than 200,000 interventional spine procedures reported an overall infection rate of 0.04 percent for facet joint procedures (Santiago et al., Pain Physician, 2021). Across nerve block studies in the knee, shoulder, hip, and SI joint, reported adverse events are minimal and transient (Toubasi et al., Cureus, 2025).
- Common (mild and temporary):
- Soreness or bruising at the injection site
- Temporary numbness in the area
- Mild headache
- Uncommon:
- Allergic reaction to the anesthetic or contrast dye
- Temporary increase in pain before improvement
- Vasovagal reaction (lightheadedness)
- Rare:
- Infection at the injection site
- Nerve damage
- Bleeding (more likely in patients on blood thinners)
Patients with active infections, bleeding disorders, or known allergies to local anesthetics should inform the physician before the procedure. Your physician will discuss specific risks based on the type of block planned.
Diagnostic vs. Therapeutic Nerve Blocks
Patients often ask whether a nerve block is meant to diagnose the pain or to treat it. The answer depends on the type of block and the goal of the procedure.
- Diagnostic nerve blocks use only local anesthetic. Their purpose is to confirm or rule out a specific structure as the pain generator. Medial branch blocks and lateral branch blocks are primarily diagnostic, since their main role is to identify candidates for radiofrequency ablation. The numbing effect is temporary by design.
- Therapeutic nerve blocks add a corticosteroid to provide longer-lasting anti-inflammatory effects in addition to the immediate numbing. Suprascapular nerve blocks, genicular nerve blocks, and femoral and obturator nerve blocks for hip pain are often performed therapeutically, with relief that can last weeks to months.
Many nerve blocks serve both purposes simultaneously: the immediate numbing confirms the diagnosis, while the corticosteroid provides extended relief. The physician selects the medication and approach based on the specific condition.
What Happens Next: From Diagnostic Block to Long-Term Relief
The next step depends on the response to the block.
- If the block provides significant relief (positive response): For spine, knee, and SI joint pain, the physician may recommend a confirmatory second diagnostic block, often using a different local anesthetic. This two-block protocol reduces false-positive rates and identifies the patients who are most likely to benefit from radiofrequency ablation, a procedure that uses controlled heat to interrupt pain signals from the target nerves for six months or longer.
A 2015 multicenter study found that patients selected through medial branch blocks achieved 50 percent or greater pain relief at three months post-radiofrequency ablation at a significantly higher rate than patients selected by intra-articular injection (P=0.041) (Cohen et al., Reg Anesth Pain Med, 2015). A systematic review of dual medial branch block protocols with strict relief criteria reported substantially better RFA outcomes than less rigorous selection (Schneider et al., Pain Med, 2020), and a 2023 pragmatic trial documented a 70 percent responder rate at three months in dual-block patients selected with an 80 percent relief threshold (McCormick et al., Pain Med, 2023).
For shoulder and hip pain, the physician may recommend repeat therapeutic blocks combined with physical therapy, or, in select cases, radiofrequency ablation of the suprascapular nerve or hip articular branches.
- If the block does not provide meaningful relief (negative response): This is still a valuable clinical finding. It indicates that the suspected nerve is likely not the primary pain generator, allowing the physician to redirect the evaluation toward other potential causes. Additional diagnostic options may include epidural steroid injections, advanced imaging, or evaluation for non-musculoskeletal contributors to pain.
Cost and Insurance
Most major insurance plans, including Medicare, cover medically necessary nerve block injections. Coverage typically requires documentation that conservative treatments (physical therapy, anti-inflammatory medication) have not provided adequate relief. The number of covered blocks per region per year and prior authorization requirements vary by plan.
Cost depends on insurance coverage, the number of nerves treated in a single session, whether the block is purely diagnostic or includes corticosteroid, and whether sedation is used. The office team can verify benefits and provide a cost estimate before the procedure is scheduled. For coverage questions, contact the Houston office at 346-217-1111.
Nerve Block Injections at Our Houston Office
Performance Pain and Sports Medicine performs nerve block injections at the Houston office in the T-Mobile Tower, Suite 1700, at 4126 Southwest Freeway, Houston, TX 77027. The office is conveniently located where I-59 meets the 610 West Loop, minutes from the Galleria, River Oaks, Bellaire, and West University Place. Covered parking with validation is provided. The Houston office serves patients from across greater Houston, including the Texas Medical Center, the Energy Corridor, and Sugar Land.
The Houston clinical team includes two interventional pain physicians, each performing nerve block procedures under fluoroscopic guidance:
- Dr. Suzanne Manzi, MD, quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. Fellowship-trained at Michigan State University in Interventional Spine and Pain Management.
- Dr. Matthias Wiederholz, MD, quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Sports Medicine, and Anti-Aging, Regenerative and Functional Medicine. Founder of Performance Pain and Sports Medicine since 2009.
The Houston practice handles the full diagnostic-to-treatment pathway under one roof. A patient who needs a diagnostic medial branch block, a confirmatory second block, and ultimately radiofrequency ablation receives all three procedures from the same physician, in the same office, with continuity of imaging, records, and clinical decision-making.
The Houston office accepts most major commercial insurance, Medicare, and workers’ compensation. To schedule an evaluation, call 346-217-1111 or contact us online. The office also provides nerve block injections at the League City, Baytown, and Lawrenceville, NJ locations.
Performance Pain and Sports Medicine
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, Suite 1700
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Phone: 346-217-1111
Frequently Asked Questions
Are nerve block injections painful?
Most patients describe mild pressure or a brief sting when the local anesthetic numbs the skin. The procedure itself typically causes minimal discomfort. Sedation is available for patients who prefer it.
How long does a nerve block last?
Pure diagnostic blocks (with anesthetic only) usually wear off within several hours. When corticosteroid is added, relief can last weeks to months. For radiofrequency ablation, which follows positive nerve block testing, relief commonly lasts six months to a year or longer.
Are nerve blocks the same as cortisone shots?
Not exactly. A nerve block targets a specific nerve carrying pain signals, while a cortisone shot is typically placed inside a joint. Both may use corticosteroid, but the location and clinical purpose differ. Your physician will recommend the approach that fits your diagnosis.
Do you sedate patients for nerve blocks?
Sedation is optional. Many patients complete the procedure comfortably with only local anesthetic at the injection site. For patients with significant anxiety or for longer procedures, mild sedation can be arranged.
Can I drive home after a nerve block?
Patients who receive only local anesthetic at the injection site can usually drive home. Patients who receive sedation or have a lower extremity nerve block (knee or hip) need someone to drive them.
What if my nerve block does not work?
A negative result is still clinically useful. It indicates the suspected nerve is likely not the pain source, allowing the physician to redirect diagnostic efforts toward other potential causes.
How many nerve blocks can I receive in a year?
This depends on the type of block, the medication used, and your insurance plan. Diagnostic blocks are typically performed once or twice for a given region. Therapeutic blocks with corticosteroid are usually spaced at least three months apart to limit cumulative steroid exposure.
Does insurance cover nerve blocks?
Most major insurance plans and Medicare cover medically necessary nerve blocks. Prior authorization is often required. The office team verifies coverage before scheduling.
What is the difference between a nerve block and radiofrequency ablation?
A nerve block uses local anesthetic to temporarily numb a nerve, lasting hours to months. Radiofrequency ablation uses controlled heat to disable the nerve’s pain-signaling capacity for six months or longer. A nerve block is typically the diagnostic step that identifies candidates for radiofrequency ablation.
Where are the Houston office and other Performance Pain locations?
The Houston office is at 4126 Southwest Freeway, Suite 1700, Houston, TX 77027. Performance Pain and Sports Medicine also performs nerve block injections at offices in League City, Baytown, and Lawrenceville, NJ.
Schedule Your Nerve Block Evaluation in Houston
For patients in Houston living with chronic back, neck, knee, hip, shoulder, or sacroiliac joint pain that has not responded to conservative treatment, a nerve block injection may be the next step toward a clear diagnosis and effective relief. Contact Performance Pain and Sports Medicine or call 346-217-1111 to schedule a consultation with Dr. Suzanne Manzi, MD or Dr. Matthias Wiederholz, MD.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Performance Pain and Sports Medicine
Dr. Suzanne Manzi, MD · Dr. Matthias Wiederholz, MD · Jade Nemeth, PA-C
Medically reviewed by Suzanne Manzi, MD
Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine
Last reviewed: May 2026
