This diagram illustrates the target area for a paravertebral block, shaded in purple, relative to surrounding body structures. A block would be performed by inserting a needle from the back (bottom part of the diagram) and advanced into the purple space.
Hospital researchers from Lawson Health Research Institute have published a recent study that assessed the use of a specialized treatment for chronic pain and its impact on health care use and opioid prescribing.
Paravertebral blocks (PVBs) belong to a broader group of procedures called “nerve blocks.” A recent Toronto Star report noted that OHIP has been billed $420 million for nerve block procedures since 2011. PVBs involve injecting medication around the nerves where they exit the bones of the spine, at different locations depending on the patient and the chronic pain they are experiencing.
The regular use of these procedures has been questioned by health care providers due to the high cost and limited evidence of their benefit in reducing chronic pain. While the effectiveness of PVBs has been examined in trauma, cancer pain and regional anesthesia during surgery, they have not been evaluated for use in chronic pain despite widespread use in Ontario.
It is estimated that one in five Canadians live with chronic pain. Pain that persists can affect all aspects of someone’s life and health, particularly when it is not being managed.
“Frequent use of PVB is common. Initiating treatment with PVCs is associated with marked increases in health care utilization, which includes physician visits and other injection procedures,” explains Dr. Eldon Loh, Lawson Associate Scientist and Physiatrist at St. Joseph’s Health Care London.
This research provides a broad perspective on the use of PVBs in Ontario, and on the use of nerve blocking treatments in general. There has been a concern for several years about the over use of these procedures; however, this is the first study to systematically document the impact on health care utilization and opioid use.
“We hope that from this study, the appropriate use of PVBs and other pain interventions will be re-evaluated at a provincial level to ensure the use of health resources is being properly managed and we achieve the best outcome for patients,” Dr. Loh adds.