Nerve Blocks in Personal Injury: Types, Agents, and the Pharmacy Lien for Oral Adjunct Medications

James Wong — Founder & Pharmacist, LienScripts | February 21, 2026 | 8 min read

Nerve blocks are a targeted pain intervention used across a spectrum of personal injury conditions — from post-traumatic headache to CRPS. Learn which nerve block types are used in PI, what agents are injected, how oral medications complement blocks rather than replace them, and how the pharmacy lien covers the adjunct medication component.

What Is a Nerve Block in the Context of Personal Injury?

A nerve block is the injection of a pharmacologic agent — most commonly a local anesthetic, sometimes combined with a corticosteroid — at or around a specific nerve or nerve plexus to interrupt pain signaling. Unlike epidural injections or facet procedures that target the spine directly, nerve blocks target peripheral nerves or their origins, making them highly specific interventions for defined pain distributions.

In personal injury, nerve blocks serve two broad purposes:

Diagnostic — Temporary blockade of a nerve with short-acting local anesthetic confirms or rules out that nerve as a significant pain generator. A patient whose headache resolves completely for the duration of a greater occipital nerve block has diagnostic evidence of occipital neuralgia or occipital-mediated post-traumatic headache — information that guides both treatment and the demand package narrative.

Therapeutic — Repeated nerve blocks, or blocks with corticosteroid added, provide sustained pain relief that allows patients to participate in physical therapy, improve function, and avoid or delay more invasive procedures.

[!KEY] Nerve blocks are often underutilized in personal injury treatment planning. When indicated, they provide both clinical benefit and objective diagnostic documentation — making them valuable tools for both the patient's recovery and the attorney's demand package.

Occipital Nerve Blocks for Post-Traumatic Headache

Post-traumatic headache is one of the most common sequelae of motor vehicle accidents, falls, and assault — particularly following concussion or mild traumatic brain injury (mTBI). The International Classification of Headache Disorders (ICHD-3) formally recognizes post-traumatic headache as a distinct entity, defined as headache developing within seven days of head trauma.

The greater and lesser occipital nerves arise from the cervical nerve roots (C2, C3) and traverse the posterior scalp. In post-traumatic headache, these nerves are frequently sensitized — either from direct cervical injury, whiplash-related paraspinal hypertonicity compressing the nerves, or central sensitization following mTBI.

Greater occipital nerve block (GONB): A small volume of local anesthetic — lidocaine 1–2% or bupivacaine 0.25–0.5% — is injected at the medial aspect of the superior nuchal line, where the greater occipital nerve pierces the trapezius fascia. Corticosteroid (betamethasone or triamcinolone) is often added for therapeutic use. The procedure takes minutes and can provide relief lasting days to weeks.

A positive GONB — with headache resolution matching the expected anesthetic duration — confirms the greater occipital nerve as a primary pain generator. This supports the treatment plan and the causation narrative: the patient's headache arose from the cervical and occipital structures injured in the accident, not from a pre-existing primary headache disorder.

[!SOURCE] Inan N, et al. "Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study." Acta Neurol Scand. 2015;132(4):270–277. PMID: 25645215. Evidence supporting occipital nerve blocks as an effective therapeutic intervention for refractory headache — relevant to post-traumatic headache management in PI patients.

Stellate Ganglion Block for CRPS and PTSD

The stellate ganglion is a sympathetic nerve ganglion located at the junction of the C7 and T1 vertebral bodies, adjacent to the carotid artery in the neck. It provides sympathetic innervation to the head, neck, and upper extremity. In personal injury, stellate ganglion block (SGB) is used in two distinct clinical contexts:

Complex Regional Pain Syndrome (CRPS): CRPS is a devastating chronic pain condition that occasionally develops following extremity injuries — crush injuries, fractures, surgical trauma, or even soft tissue injuries. The sympathetically maintained pain of CRPS responds, in some patients, to sympathetic blockade. The SGB — performed under ultrasound or fluoroscopic guidance — interrupts the abnormal sympathetic activity that drives the burning, allodynia, and vasomotor dysregulation of CRPS.

CRPS in a personal injury case represents one of the highest-value diagnoses. The diagnosis must be established rigorously: Budapest Criteria should be documented by the treating physician, and the response to SGB or other sympathetic blocks becomes part of the confirmatory picture.

PTSD following traumatic injury: Emerging research suggests that SGB may modulate the noradrenergic overactivity in the locus coeruleus associated with PTSD symptoms. While SGB for PTSD is not yet standard of care, it is being performed in select pain clinics and psychiatric contexts, particularly for patients with trauma-related hyperarousal who did not respond to medications. In severe MVA or assault cases where PTSD complicates the pain picture, SGB may appear in the treatment record.

[!SOURCE] McLean B. "Safety and patient acceptability of stellate ganglion blockade as a treatment adjunct for combat-related post-traumatic stress disorder: a quality assurance initiative." Cureus. 2015;7(9):e320. PMID: 26623174. Documents SGB use in trauma-related PTSD — relevant to PI cases involving significant psychological injury.

Selective Nerve Root Blocks

A selective nerve root block (SNRB) targets a specific spinal nerve root at the level where it exits the neural foramen. Unlike a transforaminal epidural steroid injection — which deposits medication in the epidural space and can spread to adjacent levels — a true SNRB delivers a small volume of local anesthetic (and sometimes steroid) to a precisely identified nerve root.

SNRBs are used in PI primarily for diagnostic purposes when multi-level imaging abnormalities make it unclear which level is generating the patient's radicular symptoms. By blocking one nerve root at a time and recording the patient's response, the interventional pain physician can identify the symptomatic level.

From a litigation standpoint, a positive SNRB identifying a specific nerve root as the pain generator:

• Confirms causation at a specific anatomical level correlatable to the accident mechanism.
• Provides the expert witness with objective diagnostic evidence of nerve root involvement.
• Justifies surgical intervention at that level if conservative treatment fails.

Celiac Plexus and Hypogastric Plexus Blocks

In personal injury cases involving abdominal trauma — blunt abdominal injury in a pedestrian accident, seatbelt injury in a frontal collision, or crush injury in a workplace incident — visceral pain can be the primary complaint. The celiac plexus and superior hypogastric plexus are sympathetic nerve structures that transmit visceral pain signals from abdominal and pelvic organs.

Celiac plexus block: Targets sympathetic innervation of abdominal organs. Used for post-traumatic abdominal pain, including pain following abdominal surgery that was necessitated by the injury. The block is performed under CT or fluoroscopic guidance, placing a needle adjacent to the L1 vertebral body near the aorta.

Hypogastric plexus block: Targets pelvic visceral pain — relevant in PI cases involving pelvic fracture, bladder injury, or sexual assault with pelvic pain sequelae.

These blocks are less common in routine MVA cases but appear in the treatment records of severe trauma cases and should be recognized and documented appropriately in the demand package.

How Nerve Blocks Complement — Rather Than Replace — Oral Medications

A critical principle in pain management is that nerve blocks are not a replacement for oral pharmacotherapy. They are complementary interventions that address the acute pain crisis, confirm the pain generator, or provide a window of relief that allows the patient to engage in rehabilitation. Between blocks, oral medications remain the foundation of daily pain management.

[!KEY] The pharmacy lien covers the oral and topical medications patients need between nerve block appointments — not the injectables administered at the procedure. Both the block record and the medication fill record together tell the complete treatment story.

Between occipital nerve block appointments: Patients with post-traumatic headache continue oral preventive and abortive medications between blocks: triptans (sumatriptan, rizatriptan) for acute attacks, topiramate or propranolol for prevention, amitriptyline or nortriptyline as low-dose central sensitization modulators, and NSAIDs or acetaminophen as first-line abortives.

Between stellate ganglion block sessions for CRPS: CRPS patients require sustained oral medication between SGB appointments. Gabapentin or pregabalin addresses the neuropathic pain and central sensitization component. Low-dose naltrexone (LDN) has emerging evidence for CRPS modulation. Topical compounded agents (ketamine, amitriptyline, lidocaine formulations) are applied to the affected extremity between sessions.

After selective nerve root blocks: While awaiting surgical consultation or RFA, patients continue oral NSAIDs, gabapentinoids, and muscle relaxants. The SNRB may have provided temporary relief that helped the patient tolerate physical therapy — but the relief is not permanent without definitive treatment of the underlying structural pathology.

For patients with any nerve block in the treatment record: Documenting the oral medication fills that run concurrently with the block series demonstrates to the insurer or defense counsel that the patient's pain was not adequately controlled by injections alone — that daily pharmacotherapy was required throughout the treatment course.

Documentation for the Demand Package

A nerve block series documented for the demand package should include:

1. Referral and clinical indication notes — the referring provider's documentation of the pain complaint, its characteristics, its relationship to the accident, and the rationale for nerve block referral.
2. Procedure records for each block — date, block type, nerve(s) targeted, agent and volume injected, fluoroscopic or ultrasound confirmation of placement, patient's immediate response.
3. Follow-up response documentation — the pain diary or follow-up visit note recording the duration and percentage of relief following each block.
4. For diagnostic blocks: Documentation of the response relative to the expected anesthetic duration — confirming positive or negative diagnostic outcome.
5. Imaging and diagnostic workup — MRI, CT, or nerve conduction studies that corroborate the pain generator identified by the block.
6. Pharmacy lien medication summary — all oral medications filled on lien during the nerve block treatment period, organized chronologically and by prescribing provider.

Post-Concussive Headache and CRPS: Two High-Stakes PI Scenarios

Post-concussive headache is among the most litigated neurologic injuries in personal injury. When a patient develops persistent headache following mTBI — with a positive occipital nerve block series demonstrating occipital nerve involvement — the combination of neurologic documentation and interventional response creates a compelling damages narrative. The oral medications required for chronic headache management (preventives, abortives, sleep aids for the sleep disruption that perpetuates headache) represent months to years of pharmacy lien-covered fills.

CRPS is a catastrophic outcome in a subset of extremity injury cases. A personal injury patient who develops CRPS following a fracture or surgical repair — with documented Budapest Criteria, positive SGB response, and sustained oral medication need — presents one of the highest-value pharmacy lien treatment profiles in the practice. CRPS medications (gabapentinoids, low-dose naltrexone, topical compounds, ketamine infusion adjuncts) require continuous filling across the life of the case.

Coordinating the Pharmacy Lien Alongside Nerve Block Care

LienScripts works with personal injury attorneys and pain management physicians to ensure oral and topical medications are covered from the first prescription, concurrent with and between nerve block procedures. For patients in a nerve block treatment protocol, the lien program provides:

• Immediate coverage of oral preventive and abortive headache medications for post-traumatic headache patients beginning at the first neurology or pain management visit.
• Continuous coverage of neuropathic pain agents and topical formulations for CRPS patients throughout the SGB series.
• Coverage of all oral medications used between SNRB or other diagnostic block appointments while surgical or RFA candidacy is evaluated.
• A complete, chronologically organized medication summary for the attorney at demand package assembly.

This ensures patients maintain uninterrupted medication access throughout a treatment course that may span months — and that every treatment dollar is captured as a documented lien balance recoverable at settlement.

Related Resources

• What Is a Pharmacy Lien? A Plain-Language Guide
• Epidural Steroid Injections in Personal Injury: Medications and the Pharmacy Lien
• Concussion and TBI Medication Guide for Personal Injury
• Low-Dose Naltrexone for Chronic Pain After an Accident