Theparavertebralfascialplaneblock:Anovel,ultrasound-guidedtechniqueforparaspinalneckandbackpain

Myofascial pain syndrome (MPS) is an extremely common condition that affects up to 85% of adults at some point in their lives and is a leading cause of neck and back pain complaints seen in emergency departments. Despite how frequently patients present with this problem, conventional treatments often fall short. Standard approaches like oral pain medications and traditional trigger point injections typically provide only temporary relief and may not address the underlying source of pain. Emerging research has increasingly pointed to fascia—the connective tissue surrounding muscles—as a key driver of pain in MPS, rather than muscle tissue alone.

This shift in understanding has opened the door to new treatment approaches that target the fascial planes between muscles rather than injecting directly into muscle. Given these developments and the growing use of ultrasound-guided procedures in emergency medicine, the researchers developed a novel technique called the paravertebral fascial plane block (PFPB) to specifically target these fascial structures in patients with difficult-to-treat paraspinal pain.

The researchers conducted a retrospective observational study at a single academic medical center, reviewing all patients who received the PFPB procedure over a one-year period from September 2024 to August 2025. They included adult emergency department patients who had paraspinal pain consistent with myofascial pain syndrome and who either had not responded adequately to standard emergency department pain medications or had a documented history of recurrent, hard-to-treat paraspinal MPS. The PFPB procedure had two main parts: first, injection of a combination of local anesthetic (bupivacaine), normal saline, and sometimes dexamethasone into the fascial plane between the superficial back muscles and the deeper erector spinae muscle; and second, deliberate needling of the fascial layers under ultrasound guidance. The treating physician used ultrasound to visualize the exact anatomical plane and performed 10 or more needle passes through the fascia.

Pain scores were collected as part of routine clinical care at three time points: before the procedure, at emergency department discharge, and 24-48 hours later via telephone follow-up. The researchers then analyzed these scores to see how much pain relief patients experienced.

Eleven patients underwent the PFPB procedure during the study period. The group had a median age of 48 years and was 64% female. The majority of patients (73%) had first tried standard emergency department medications without adequate relief, while the remaining 27% had known refractory MPS and went straight to the procedure. The PFPB was performed at various spinal levels: cervical in 2 patients, thoracic in 4 patients, and lumbar in 5 patients.

Five patients (45%) received bilateral blocks.

The pain reduction was substantial and rapid. The median pain score on the 0-10 Numeric Rating Scale was 9 out of 10 before the procedure, which dropped significantly to 3 out of 10 at emergency department discharge—a 67% relative reduction. This improvement was statistically significant with a p-value of 0.004. At 24-48 hour follow-up, which 10 of 11 patients completed, the median pain score had fallen further to 1 out of 10, representing an 89% reduction from the original baseline (p=0.006).

Importantly, 80% of patients with follow-up data reported either further improvement or sustained relief compared to their discharge pain levels. Only 20% reported mild recurrence of pain, though even these patients remained below their original baseline pain levels. The difference between discharge and follow-up scores was not statistically significant (p=0.265), suggesting the initial relief was maintained rather than fading.

No procedural complications or adverse events occurred in any patient. None of the treated patients returned to any emergency department in the health system within 48 hours of discharge.

These findings suggest that the paravertebral fascial plane block may be a promising new option for patients with severe, refractory paraspinal myofascial pain syndrome in the emergency department setting. The procedure appeared to provide both rapid and sustained pain relief, with most patients experiencing dramatic improvement that lasted at least 24-48 hours. The absence of any complications in this initial series, combined with the superficial needle approach under direct ultrasound visualization, suggests a favorable safety profile compared to deeper injection techniques that carry risks like pneumothorax.

For patients, this represents a potential alternative when standard medications fail to provide adequate relief, or when they have recurrent episodes that have been difficult to manage. The procedure specifically targets fascial tissue rather than muscle, which aligns with newer understanding of how MPS generates pain. For clinicians, particularly emergency physicians with ultrasound training, the PFPB offers a reproducible technique that can be applied across all spinal levels using consistent anatomical landmarks.

However, the researchers appropriately caution that these are preliminary findings from a small, single-center retrospective study without a control group. The small sample size of 11 patients limits statistical power and prevents subgroup analyses. Because the procedure combines multiple elements—saline hydrodissection, anesthetic injection, fascial needling, and sometimes steroid—it remains unclear which components contribute most to the observed benefit. Patients also received varying combinations of pre-procedure medications, making it impossible to completely separate the PFPB effect from other treatments.

The 24-48 hour follow-up window is too short to assess longer-term durability or recurrence patterns. Larger, prospective, controlled studies will be needed to validate these encouraging initial results and determine the precise role of this technique in emergency pain management.