Nerve Block and Trigger Point Injections for Neuralgia and Myalgia
Assessment of Medical Necessity
- Peripheral nerve blocks are considered to have insufficient evidence for the treatment or prevention of headaches, including migraine headaches, according to the American Society of Anesthesiologists 1, 2
- Peripheral nerve blocks should only be used for chronic pain as part of an active component of a comprehensive pain management program, as recommended by the American Society of Anesthesiologists 1
- The American Society of Anesthesiologists notes that patients with chronic migraine without aura require a comprehensive pain management approach, which may include nerve blocks, but only as part of a larger program 3, 4
Evidence Analysis
- Multiple guidelines, including those from the American Society of Anesthesiologists, indicate insufficient evidence for peripheral nerve blocks for headache management, with a lack of standardization in techniques, types, and doses of local anesthetics used 2, 5
- The American Society of Anesthesiologists recommends against trigger point injections for chronic low back pain without radiculopathy, citing a lack of evidence for long-term benefit 3
- The American Society of Anesthesiologists notes that peripheral somatic nerve blocks should not be used for long-term treatment of chronic pain, and that trigger point injections may provide short-term relief but lack evidence for long-term benefit 6, 7, 8, 5