Local anesthetic blocks have limited value in diagnosing and treating chronic pain. Peripheral nerve blocks have shown some utility in treating occipital neuralgia and meralgia paresthetica. Sympathetic blocks of the upper and lower extremities can provide pain relief to facilitate functional restoration in patients with complex regional pain syndrome. Neurolytic celiac plexus block can provide effective pain relief in those with cancer-related pain of the abdominal viscera. Epidural injection of steroids has proven beneficial for reducing the severity and duration of acute radicular pain associated with intervertebral disc herniation. In patients with chronic neck or low back pain related to facet arthropathy, diagnostic blocks of the medial branch nerves can identify those patients who are most likely to attain durable pain relief with radiofrequency neurolysis. © 2011 Blackwell Publishing Ltd.