The 3-Month Rule: When Your Medial Branch Block Wears Off (And Your Next Best Options)

It’s been exactly 12 weeks since your medial branch block. You know because you’ve been counting.

For three glorious months, you could bend without wincing. Sleep through the night. Pick up your grandkids without that sharp catch in your lower back. But this morning, that familiar ache returned. By afternoon, the stiffness was back. By evening, you’re reaching for the heating pad and wondering if this is just your life now—three months of relief followed by pain, over and over again.

If this sounds familiar, you’re experiencing what we call the “3-month fade.” It’s as predictable as Arizona sunshine, and just about as welcome as our summer heat when you’re stuck in a car with broken air conditioning. The good news is that at Arizona Pain and Spine Institute, Dr. Asim Khan and Dr. Daniel Ryklin see this pattern every day. More importantly, they have a plan for what comes next.

Understanding Why Your Block Wore Off

Let me ease your mind about something right away: your medial branch block wearing off doesn’t mean it failed. Quite the opposite, actually. If you got two to three months of relief, that injection did exactly what it was supposed to do.

You see, medial branch blocks were never intended to be permanent. They’re designed to be temporary for several very good reasons. First and foremost, they’re diagnostic. Think of them like a test drive for your pain relief. By numbing those specific nerves that supply your facet joints, we confirmed that yes, those joints are indeed the troublemakers causing your back pain. That’s incredibly valuable information that many people search months or even years to discover.

The temporary nature also serves as a therapeutic bridge. For those three months, your body got a break from the constant pain signals. You probably found yourself moving more, sleeping better, maybe even forgetting about your back for blessed stretches of time. Your muscles relaxed, your posture improved, and that vicious cycle of pain causing tension causing more pain was interrupted.

There’s also a practical insurance consideration that most patients don’t know about. Insurance companies, in their infinite wisdom, require successful medial branch blocks before they’ll approve longer-lasting procedures. Consider those three months of relief your golden ticket to treatments that can last a year or more.

Dr. Khan puts it perfectly when he tells his patients, “When that familiar pain returns after a successful block, I actually smile. Not because I want you in pain, but because now we know exactly what’s wrong and exactly how to fix it long-term.”

The Natural Next Step: Radiofrequency Ablation

For most patients whose medial branch blocks provided good relief, the logical progression is to radiofrequency ablation, or RFA as we call it. Think of it this way: if the medial branch block was like putting your finger over a garden hose to stop the water temporarily, RFA is like installing a valve that stays shut for a much longer time.

The procedure itself is remarkably similar to what you’ve already experienced with your block. You’ll come into the same comfortable procedure room at Arizona Pain and Spine Institute. Dr. Ryklin or Dr. Khan will use the same type of X-ray guidance to locate those exact nerves that were blocked before. But here’s where it gets interesting. Instead of just numbing the nerves with medication, they use carefully controlled heat—radiofrequency energy—to actually disable the nerve’s ability to transmit pain signals.

Now, I know what you’re thinking. Heat? On my nerves? It sounds more dramatic than it actually is. The temperature is precisely controlled, just enough to interrupt the pain signals without causing any damage to surrounding tissues. The whole procedure takes about 30 to 45 minutes, and you’ll have mild sedation to keep you comfortable. Most patients tell us they barely remember it.

The recovery is where patience becomes important. For the first few days, you might have some soreness at the injection sites—nothing worse than what you experienced with your original block. Then something interesting happens. Around week two, some patients actually feel worse before they feel better. Dr. Ryklin warns every patient about this: “Those nerves don’t go quietly. They might protest for a week or two before they finally quiet down. Don’t panic. This is normal and it means the procedure is working.”

By week three or four, that’s when the magic happens. The pain starts fading, not just for a few months, but for much longer. Most of our patients get nine to eighteen months of relief, and some lucky folks get even longer. When it eventually wears off—because nerves are persistent little things and eventually regenerate—the procedure can be repeated with the same excellent results.

When RFA Isn’t the Right Choice

Now, RFA isn’t always the immediate next step for everyone. Sometimes we need to think strategically about your particular situation.

For instance, if you’re someone who got relief from the block but it only lasted six weeks instead of three months, that tells us something important. Maybe the facet joints aren’t the only problem. Maybe there’s some arthritis in the joints themselves that needs addressing, not just the nerves that supply them. This is where Dr. Khan’s innovative approach comes in.

He’s pioneered combining medial branch blocks with platelet-rich plasma injections, or PRP. Here’s how it works: we block the nerve pain just like before, giving you that immediate relief you need. But in the same visit, we also inject PRP directly into the facet joints themselves. The PRP, which comes from your own blood, contains growth factors that can actually help heal the damaged tissue in the joints. It’s like killing two birds with one stone—immediate relief from the block, and potential longer-term healing from the PRP.

The catch, and there’s always a catch, is that insurance doesn’t cover the PRP portion. It runs between $1,500 and $4,000 depending on how many joints we’re treating. But for younger patients, say those in their fifties and sixties with early arthritis, this investment in actual healing rather than just pain management can be worthwhile.

The Story of Finding the Right Progression

Let me tell you about Susan, because her journey illustrates perfectly how this treatment progression works in real life. Susan is a 58-year-old second-grade teacher from Gilbert who came to us with classic facet joint pain. She’d been suffering for two years, unable to sit through story time with her students without shifting constantly in pain.

Her first medial branch block was, in her words, “like someone gave me my life back.” For three beautiful months, she taught without pain, played with her grandchildren, even went hiking in Sedona with her husband—something she hadn’t done in years. When the pain started creeping back around week eleven, she called our office in tears, thinking she was back to square one.

Dr. Ryklin sat down with her and explained that this was actually excellent news. The block had done its diagnostic job perfectly. We knew exactly which nerves were causing her pain, and now we could offer her something longer-lasting. She had her RFA the following month.

“I won’t lie,” Susan told us later, “those first two weeks after the RFA were rough. The pain was actually worse than before the procedure. But Dr. Ryklin had warned me this might happen, so I didn’t panic. I just kept telling myself, ‘The nerves are angry before they quiet down.’ And sure enough, by week three, the pain started fading. By week six, I felt better than I had in years.”

That was fourteen months ago. Susan’s just starting to feel some mild pain returning, but there’s no fear this time. She knows exactly what to do. She’s already scheduled for another RFA next month. No more guessing, no more suffering through failed treatments—just a clear, proven path forward.

When Insurance Makes You Wait

One of the most frustrating aspects of this whole process is when you know what works, but insurance makes you wait. You’ve had a successful block, you’re a perfect candidate for RFA, but the insurance company wants to review, consider, contemplate, and generally take their sweet time while you’re suffering.

This is where Arizona Pain and Spine Institute’s FastTrack program becomes a game-changer. It’s a cash-pay option that lets you get your RFA within days, not weeks or months. The pricing is transparent and often less than what you’d pay toward your deductible anyway. They offer payment plans to make it accessible, and they can even bundle treatments for additional savings.

Dr. Khan feels strongly about this: “Patients shouldn’t have to suffer because insurance companies drag their feet. Pain doesn’t wait for prior authorization, and neither should relief.”

Knowing When to Move Beyond RFA

Sometimes, despite our best efforts, the progression from blocks to RFA isn’t enough. If you’ve had multiple blocks with decreasing effectiveness, or if your RFA only lasted a few months instead of a year, it might be time to consider more advanced options.

This is where the expertise of Dr. Khan and Dr. Ryklin really shines. They’re among the few physicians in the Valley trained in spinal cord stimulation, including the advanced DRG stimulation technique. For patients whose facet joint pain has become centralized—meaning the nervous system itself is stuck in pain mode—these devices can provide continuous, adjustable pain control.

The beautiful thing about spinal cord stimulation is that you get to try it before committing. There’s a week-long trial period where you wear an external device to see if it helps. Only if you get good relief do you move forward with the permanent implant. It’s like those medial branch blocks all over again—we test before we treat.

Your Personal Decision Framework

So how do you know which path is right for you when your medial branch block wears off? It really comes down to a few key factors that you should discuss with Dr. Khan or Dr. Ryklin.

First, consider how long your relief lasted. If you got a solid two to three months, RFA is likely your best bet for extended relief. If the block only helped for a few weeks, you might need additional diagnostic work to identify other pain sources.

Think about your lifestyle and goals. Are you someone who wants the longest possible relief between procedures? RFA is your answer. Are you actively working on weight loss or strengthening programs and just need periodic relief while you improve your core stability? Strategic repeated blocks might make more sense.

Consider your timeline. Do you have a daughter’s wedding coming up? A long-planned cruise? The FastTrack program can ensure you’re pain-free for important life events without waiting for insurance approvals.

And yes, budget matters. If you have good insurance with a low deductible, following the standard progression makes financial sense. If you have a high deductible plan or are interested in regenerative options that might provide actual healing rather than just pain management, the cash-pay combinations might be worth exploring.

Taking Action Before Pain Takes Over

Here’s what I want you to remember: that familiar pain creeping back after your medial branch block isn’t a failure. It’s not a sign that you’re destined to suffer. It’s simply your body telling you it’s time for the next phase of your treatment plan.

The key is not to wait until you’re back in severe pain. The sooner you act after your block wears off, the easier it is to maintain the progress you’ve made. Those muscles that finally relaxed? Let’s keep them that way. That improved sleep pattern? Let’s not lose it. That ability to enjoy life without constantly thinking about your back? That’s worth protecting.

When you call Arizona Pain and Spine Institute at (480) 986-7246, tell them your medial branch block has worn off and you need to discuss next options. Bring any records of your previous blocks and how long they lasted. Ask about RFA timelines and whether FastTrack might help you get relief sooner.

Dr. Khan and Dr. Ryklin have guided hundreds of patients through this exact progression. They understand the frustration of temporary relief, the hope that comes with finding something that works, and the determination to make that relief last longer. They’re not just treating your facet joints; they’re treating you—a whole person who deserves to live without the constant burden of back pain.

Visit their website to learn more about radiofrequency ablation and other advanced treatments. Read about other patients’ experiences. Educate yourself about your options. Because when it comes to chronic pain, knowledge truly is power.

The 3-month rule doesn’t have to rule your life. With the right treatment progression, those three months can become six, twelve, eighteen months or more. The pain that’s creeping back today could be the last time you feel it for a very long time. All it takes is making that call and taking the next step in your journey toward lasting relief.

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Medical disclaimer: Individual results vary. Treatment progression depends on multiple factors including diagnosis, severity, and individual response. This information is for educational purposes. Consult with qualified physicians to determine appropriate treatment for your specific condition.