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Diagnostic Block Concordance Requirement — FRCA Final MCQ

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ModeratePain MedicineDiagnostic Block Concordance RequirementFRCA Final

A 40-year-old man presents to the pain clinic with a 6-month history of persistent burning pain in the right groin following a right inguinal hernia repair with mesh. Physical examination reveals allodynia and hyperalgesia in the right ilioinguinal nerve distribution. A diagnostic ilioinguinal nerve block provides 80% pain relief lasting 6 hours. According to Faculty of Pain Medicine guidance, what is the next management step?

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Correct answer: E — Repeat diagnostic block to confirm concordance before considering ablation or surgical neurectomy

Following a positive diagnostic nerve block (>50% pain relief), current practice recommends a CONFIRMATORY repeat block to establish concordance (consistent results) before proceeding to definitive intervention. A single positive block has a 30-40% false-positive rate. If two concordant blocks confirm the ilioinguinal nerve as the pain generator, options include: pulsed radiofrequency ablation (neuromodulation, non-destructive), surgical neurectomy (cutting the nerve), or continued pharmacological management. This stepwise diagnostic approach minimises the risk of unnecessary irreversible procedures.

Reference: Faculty of Pain Medicine – 2021 – Interventional pain procedures; NICE – 2024 – NG59 Low back pain