***Please note, I have put together an updated overview of my cervical facet block experience. You can see that post HERE.***
In March of 2008, I began to have back of the head and neck pain. I was referred to a specialist to address these issues. I wrote about my history with back of the head/neck pain and my first experience with neck injections in Cervical Facet Blocks: Undercover Investigative Report. In Update: Cervical Facet Blocks, I discussed what it was like five weeks post-procedure.
Between my initial injections and my second round of injections, I went to physical therapy twice a week. However, my back of the head/neck muscles were so tight that I did not see any significant improvement during that time.
Round two was on December 3, 2008. I received bilateral cervical facet blocks at the first joint in my spine called occipito-atlanto joint which connects the base of the skull to the spine, between C1 and C2 (first and second vertebrae of the spine) and between C2 and C3 (second and third vertebrae of the spine). These injections were at the same locations as the ones I had in September 2008. In addition, I received bilateral C2 root ganglion blocks and bilateral suboccipital peripheral nerve peripheral blocks.
This image from dartmouth.edu, points out the location of the subocciptial nerve. I really appreciate it because it shows just how many muscles are surrounding these nerves. No wonder physical therapy and/or massage aggravates my neck pain.
Recovery was more difficult from the December 2008 blocks. Emotionally, I was still struggling to regain my footing after the October 2008 hospitalization and was still having significant NDPH pain and frequent, if not daily Migraines. For nine days post-procedure, I felt as though someone had taken a two by four to the back of my head. The pain I was experiencing everywhere and the symptoms of Migraine about drove me to my breaking point. I vowed I would never have the procedure again.
However, in the coming weeks, my neck started feeling better than it had ever been before. I felt complete numbness in my neck muscles. My physical therapist was able to be more aggressive with my therapy and I felt no pain. An additional surprise was that my Migraines went away almost completely until January 6, 2009. Additionally, my NDPH also decreased to a pain level of 1-2 out of 10. A phenomenal change! We were not sure if it was directly related to the blocks or to the recent preventative medication increase, but I was satisfied with so much improvement.
Unfortunately, my menstrual Migraines in the beginning of January 2009 brought the return of my neck pain. During my hospitalization in late January to early February 2009, my neck physiatrist visited me. We discussed that although it is wonderful to have had some relief from the blocks for a few weeks, it is also unfortunate that the pain relief did not last through my menstrual cycle. So, we decided to try some other injection sites as an investigative tool to discover what might work and hopefully last somewhat longer.
On January 29, 2009, I received bilateral C2 root ganglion blocks, bilateral subocciptial peripheral nerve blocks, and bilateral Botox injections in my neck and upper back muscles including trapezius, levator, splenius and paraspinals. Because I was in the hospital, I was able to receive pain injections that facilitated my ability to handle the pain that I felt as a result of the injections. I had expressed concern to both specialists about my ability to emotionally handle more pain from the injections. They both felt that being hospitalized (as opposed to receiving the injections in outpatient one-day surgery) would be the best place for me. And it was.
One story I would like to share about this procedure, is that I woke up in the middle of it. I was under anesthesia, not heavy anesthesia, but sedated enough to not usually remember much or feel anything. I woke up and heard my physiatrist talking with another man. But, I also felt the injections that I believe were the Botox and they hurt! I finally realized I was not falling back asleep, so I said "I am awake." They were silent, and I fell back asleep. I imagine that happens time to time. Initially, my fear had always been that this situation would happen. But, it was not scary at all and actually calmed me that it happened and was not traumatic.
Although the injections initially cause me a lot of pain for many days, according to my physiatrist, this is not necessarily common across the board. Some people are more sensitive than others.
The injections I got in January 2009 were not quick to take, however I did receive eventual neck pain relief from them that lasted through my next menstrual Migraine cycle. Today, after weeks of decreased neck pain, it is on the rise again. My next menstural cycle should be soon, so it may be related or it may be the massage I just got that was a bit too much for me. I see my physiatrist mid-April in hopes that we can discuss more about next steps.