Treatments

13. Sympathetic blocks

Background: Sympathetic nerves run on the front surface of the spinal column, versus the spinal canal. As part of the autonomic nervous system, they help control blood flow, temperature regulation to the arms and legs, sweating, heart rate, digestion, and blood pressure: functions you neither think about nor actively control.

There is a crucial connection between the autonomic nervous system (where sympathetic nerves are) and the central nervous system (which you can control). When the regulation for that connection becomes altered (usually after an injury), it produces pain.

Indicated For: Complex regional pain syndrome, or Reflex Sympathetic Dystrophy (RSD).

Objective: By injecting numbing medicine around the sympathetic nerves in the low back or neck, we temporarily 'switch' off the sympathetic nerve system to reduce or eliminate pain. If relief is substantial, then we diagnose you with sympathetically mediated pain, and decide whether to repeat. The goal is to reset the sympathetic tone to a normal state.

Anticipated Relief: Often longer than expected.

Treatment: We’ll administer an IV for safety (which facilitates relaxation medicine, if needed). We’ll cleanse the skin to be injected, then numb it with numbing medicine (anesthetic), which may briefly sting. The x-ray will guide us to the sympathetic plexus of nerves. We’ll inject first contrast dye, then the medication. After 20-30 minutes, we’ll instruct you to move the affected area in the attempt to provoke your customary pain.

Driver Needed? Yes. Please refrain from driving for the rest of the day.

Post-Treatment: You may notice increased warmth in the treated area (or affected extremity) for 4-18 hours following treatment. Some patients feel relief within the first few hours after treatment. Others notice a slight increase in their pain, which lasts for several days as the numbing medicine wears off. You might also experience mild pain at the injection site for 2-3 days: if you do, feel free to ice it. If we inject the sympathetic nerves in your neck (stellate ganglion), you will also notice a slight drooping of the eyelid, and eye redness. This is normal, and should resolve in 4-18 hours. Avoid strenuous activities.

Medications: Please limit your pain medications for the first 4-6 hours after the procedure. Feel free to take your other medications post-treatment.

Pain Diary: Please report any remaining pain to us, and record your relief over the next week in your diary. Mail or fax it back so that we can plan future tests and/or treatment accordingly.

Exercise: When your pain improves, you can exercise in moderation. Start slowly, then gradually increase your activities over 1-2 weeks to avoid recurrence of pain.

Back to Patients Page/List of Treatments