Interventional pain · London
Dorsal root ganglion block and TFESI, image-guided, by a consultant.
A targeted injection for radicular leg or arm pain — fluoroscopy or CT, contrast confirmation, and particle-free steroid where it matters. Diagnostic, therapeutic, or the decision point before surgery.
Why patients choose us
- 01
A consultant interventional pain specialist or radiologist
Not a generalist injecting near the spine. A named consultant in interventional pain, interventional radiology or a spinal surgeon with a dedicated pain practice.
- 02
The right needle, the right image guidance
Fluoroscopy or CT — never blind. Contrast confirms the injectate goes where it should, and does not go into a vessel.
- 03
Particle-free steroid where it matters
At cervical levels we insist on dexamethasone rather than particulate steroid — the difference between routine relief and a catastrophic vascular event.
Indicative pricing
What a private DRG block or TFESI costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A lumbar TFESI in our network: £1,400–£2,600, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Diagnostic DRG block (single level, LA only) | £1,200–£2,200 | 30–45 min | Same visit |
| Therapeutic DRG block with steroid | £1,400–£2,600 | 30–45 min | Same visit |
| Transforaminal epidural steroid injection (TFESI) | £1,400–£2,600 | 30–45 min | Same visit |
| Cervical TFESI (particle-free steroid) | £1,800–£3,200 | 45 min | Same visit |
| Two-level block (same visit) | £2,000–£3,600 | 45–60 min | Same visit |
| Consultation only | £220–£450 | 30 min | Same visit |
Prices vary by clinic, by which consultant does the case, by whether fluoroscopy or CT is used, and by the number of levels treated. Cervical work with particle-free steroid sits at the top of the range. We come back with a firm quote within one working day.
The problem
The right level, the right needle, the right steroid.
Spinal injections are only as good as the operator, the imaging and the drug that goes down the needle. We get all three right before you agree to anything.
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MRI does not match the pain?
Two roots could be the culprit? A selective diagnostic block tells you which. That is what it is for.
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Worried about a cervical injection?
You should be — but only if it is done with particulate steroid. We insist on particle-free dexamethasone, without exception.
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Already had a discectomy?
Post-surgical radicular pain is a specific problem. DRG work has a genuine role, and a stimulator trial may be the next step.
The journey
From MRI to response — what happens, in order.
One clinician from first message to review — including the response window and the surgical decision, if one is coming.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Response and next step
- 01
Before
MRI and clinical review
A recent MRI of the spine and a clinical picture that matches — radicular pain in a specific dermatome, with a nerve root the imaging can explain.
- 02
Before
Conservative measures first
Physiotherapy, neuropathic analgesia and time. A DRG block is not the first move for most people with sciatica or brachialgia.
- 03
Before
We arrange the block
Within one to two weeks. Blood-thinning medication is reviewed with the team — never stopped without advice — and you are told exactly how to prepare.
- 04
On the day
The procedure itself
Prone on a fluoroscopy or CT table, sterile prep, local anaesthetic at the skin, a 22–25G spinal needle into the safe triangle at the foramen, contrast, then the injectate.
- 05
On the day
Home the same day
A short recovery on the unit, written aftercare, and home within a few hours. A transient heavy leg or arm is expected and settles within hours.
- 06
After
Response over two to four weeks
Diagnostic relief is immediate but short-lived. Steroid benefit builds over three to seven days and lasts weeks to months in most who respond.
- 07
After
Surgical decision or repeat
A good response confirms the pain generator — useful before a discectomy or foraminotomy. A short-lived response may be repeated, or point toward a different diagnosis.
Typical end-to-end: 1–2 weeks from enquiry to procedure. Response window: up to 4 weeks.
When it helps
When a DRG block or TFESI is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Sciatica with a matching disc
Dermatomal leg pain with a herniated disc on MRI compressing the corresponding root — the classic candidate.
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Foraminal stenosis
Nerve root pain from a narrowed exit foramen, often at L5 or S1, where a targeted block can outperform an epidural.
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Post-surgical radicular pain
Persistent nerve root pain after discectomy or fusion — often driven by fibrosis around the root, where DRG work has a role.
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Brachialgia (arm)
Radiating arm pain from a cervical root, with imaging that matches. Cervical TFESI is done with particle-free steroid only.
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Diagnostic before surgery
When two roots could plausibly be the culprit, a selective block confirms which one — a decisive test before discectomy or foraminotomy.
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Neuropathic pain, targeted level
Post-herpetic neuralgia, complex regional pain or focal neuropathic pain where a DRG is the plausible pain generator.
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DRG stimulator candidate
A short-lived but real response to a diagnostic block can identify who might benefit from an implantable DRG stimulator down the line.
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Red flag: cauda equina
Saddle numbness, new bladder or bowel disturbance, or bilateral leg weakness is an emergency — same-day A&E, not an injection booking.
Procedure options
A DRG block is not the only option.
What each option on the table actually involves — and which fits which pattern of pain.
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DRG block (diagnostic / therapeutic)
Local anaesthetic ± steroid placed just outside the neural foramen on the target root — for diagnosis, therapy, or both in one visit.
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Transforaminal epidural (TFESI)
The same needle trajectory, with injectate spread into the epidural space. Preferred for broader root and epidural pathology.
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Cervical TFESI
Particle-free steroid (dexamethasone) is mandatory — particulate steroid at cervical levels risks catastrophic spinal cord embolisation.
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Facet joint block
A different problem: axial back pain from the facet joints, not radicular pain. A useful diagnostic step for suspected facetogenic pain.
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Medial branch block and RFA
Diagnostic block of the medial branch nerves, followed by radiofrequency ablation for lasting relief of facet pain.
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Interlaminar epidural steroid
A midline epidural for multi-level or bilateral radicular pain, when a targeted transforaminal is not the best fit.
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DRG neuromodulation (implantable)
A DRG stimulator (e.g. Abbott Proclaim DRG) — an adjacent modality for chronic, focal neuropathic pain that has failed simpler measures.
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Consultation only
An honest discussion of whether a block is the right next step at all, and which one fits your imaging — no obligation.
Our vetted London network
A small panel of pain and spine specialists, we picked them.
Consultants in interventional pain, interventional radiology and spinal surgery across central, north, west and south London. Introductions are made privately, once we understand your imaging.
Selection criteria
How we choose every consultant in our network.
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Consultant interventional pain, interventional radiology or spinal surgery — not generalists
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Every case done under fluoroscopy or CT, with contrast confirmation
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Particle-free dexamethasone insisted upon for cervical TFESI
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Full pre-procedure MRI review and honest alternatives discussed
Safety and recovery
What to expect afterwards — honestly.
A DRG block or TFESI is a common, safe day-case procedure — done properly. The things worth understanding are the vascular risk at cervical levels, the response window, and what is genuinely a red flag afterwards.
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Catastrophic vascular event (cervical)
Particulate steroid at cervical levels can embolise to the spinal cord or brainstem — rare, devastating, and the reason we insist on dexamethasone.
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Epidural haematoma
A bleed around the cord or roots is very rare but serious. Blood-thinning medication is reviewed with the team before every procedure.
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Post-dural puncture headache
An inadvertent dural puncture can cause a positional headache for a few days — usually self-limiting, occasionally needs a blood patch.
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Infection, including discitis
Sterile technique and single-use kit keep the risk low, but any fever, back pain worse than before, or spreading redness needs urgent review.
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Transient limb weakness
The local anaesthetic can weaken the leg or arm for a few hours. Do not drive on the day, and have someone with you at home.
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Steroid side effects
Hyperglycaemia (matters in diabetes), fluid retention, flushing and a short blood pressure rise. HPA suppression is a concern with repeat injections.
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No benefit, or short-lived relief
Not every root is the pain generator. A negative or short-lived response is useful information, not a failure — it changes the plan.
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Allergic reaction
Rare, mostly to contrast or local anaesthetic. Tell the team about previous reactions before the procedure.
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Red flags after the block
New saddle numbness, bladder or bowel disturbance, spreading weakness or a fever are not normal — call the clinic or A&E the same day.
Reading your procedure note
Your procedure note in four parts. Read the last one first.
Whether you had a DRG block or a TFESI, the note the consultant sends you keeps to the same shape.
A quiet reminder
Interventional language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and level treated
The clinical problem — dermatomal leg or arm pain — the target level and side, and whether this was diagnostic, therapeutic or both.
- 02 Technique
Guidance, needle and injectate
Fluoroscopy or CT, needle gauge and approach, contrast pattern (extraneural, not intravascular), and the exact volume and mix of local anaesthetic and steroid.
- 03 Findings
Immediate response and any events
Pain score before and after, transient weakness, any vasovagal episode, and confirmation that no intravascular or intrathecal spread occurred.
- 04 Impression
Recovery, response window, next step
Read this first: what is normal in the first 24 hours, when steroid benefit is expected, and whether a repeat, a surgical opinion or a stimulator trial is the plan.
Recognised by major UK insurers
Cover for DRG blocks and TFESI varies by insurer and by indication — most policies fund image-guided spinal injections when clinically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about DRG blocks and TFESI.
Quick answers on how long relief lasts, cervical safety, cost, and how DRG stimulators fit in.
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What is a dorsal root ganglion block?
A dorsal root ganglion (DRG) block is an image-guided injection of local anaesthetic — usually with a steroid — placed just outside the neural foramen at a specific spinal level. It targets the sensory nerve root and is used to diagnose the source of radicular pain, to relieve it, or both.
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Is it the same as a transforaminal epidural steroid injection?
The needle trajectory is essentially the same. In a DRG block the injectate stays around the ganglion outside the foramen; in a transforaminal epidural steroid injection (TFESI) it spreads into the epidural space. Many operators use the terms interchangeably and choose the target by clinical need.
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How long does the pain relief last?
The local anaesthetic wears off in hours. Steroid benefit builds over three to seven days and typically lasts weeks to a few months in those who respond. Some people get long-lasting relief; others need a repeat, or the block confirms that surgery is the right next step.
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Is a cervical (neck) injection safe?
When done properly, yes — but only with particle-free steroid such as dexamethasone. Particulate steroid at cervical levels can embolise to the spinal cord or brainstem and cause catastrophic injury. We do not accept any other approach in the neck.
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How much does a private DRG block or TFESI cost in London?
Roughly £1,200–£2,200 for a diagnostic DRG block, £1,400–£2,600 for a therapeutic block or lumbar TFESI, and £1,800–£3,200 for a cervical TFESI with particle-free steroid. Two-level work is around £2,000–£3,600. We come back with a firm figure within one working day.
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What is a DRG stimulator?
An implantable device — Abbott’s Proclaim DRG is the best-known example — that places small electrodes onto the dorsal root ganglion for focal chronic neuropathic pain such as complex regional pain syndrome. It is an adjacent modality, not a first-line step, and a positive diagnostic block is usually needed before a trial.
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