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Lumbar Sympathetic Block

If you suffer from chronic pain in your buttock(s), leg(s) or feet that has failed to respond to conventional therapy (i.e. medication, physical therapy or even injections) you may benefit from this life-changing treatment option.

What is a Lumbar Sympathetic Block?

A sympathetic nerve block is an exciting procedure used to treat a variety of painful syndromes that are traditionally non-responsive to other modalities. In this treatment, a small amount of anesthetic is injected onto a sympathetic ganglion located on the lumbar spine, interrupting signals from the sympathetic nervous system (SNS) and causing pain relief.

The lumbar sympathetic ganglia are known for their role in sending pain signals from the buttocks, legs and feet to the brain.  By placing a small amount of local anesthetic on any one of them, not only can the pain be stopped in its tracks, but blood flow can effectively be returned to the legs and feet giving the limb a better appearance.

Indications

This type of injection was first described in the 1920’s for abdominal pain. Since that time the number of indications has grown dramatically.[1]

LSB tx  Complex Regional Pain Syndrome (CRPS), types I and II
 Neuropathy
 Phantom limb pain
 Arterial insufficiency of the lower extremity
 Raynaud’s syndrome
 Postherpetic neuralgia
 Cancer pain
 Ischemic pain
 Hyperhidrosis
 Frostbite
 Lower extremity crush injury

What Are The Benefits?

autonomic nervous sympatheticA lumbar sympathetic block is one of the most effective weapons in a pain management doctor’s arsenal. It is a minimally invasive treatment option with the potential to relieve pain when other more conventional therapies have failed. One of the most impressive things about this injection is its ability to offer immediate pain relief and allow patients to participate in physical therapy, returning them to their normal daily activities sooner. It can be used to diagnose and treat many types of pain that are non-responsive to conventional therapies: CRPS,[4] phantom limb pain,[1] postherpetic neuralgia,[5] ischemic limb pain,[6] and cancer pain.[7]

Regardless of the outcome of the procedure, your physician will be able to determine what part, if any, the SNS plays in the perpetuation of certain pain processes. In cases were there is temporary relief from a lumbar sympathetic block, a diagnosis of sympathetically-mediated pain can be established and guide further treatment – increasing the chances of success.

Learn More About the Sympathetic Nervous System

How Does It Work?

The SNS is known to play a role in neuropathic pain,[2] and the sympathetic block has proved invaluable in handling several hard-to-treat syndromes. Sympathetic blocks can be used for diagnostic, prognostic and therapeutic purposes.[3]

  1. Diagnostic: To determine if the pain is sympathetically mediated or not.
  2. Prognostic: To determine if a neurolytic procedure (i.e. radiofrequency ablation or chemoneurolysis) would be beneficial.
  3. Therapeutic: To treat a variety of conditions.

The target for a lumbar sympathetic block is the sympathetic chain and ganglia located immediately anterior to the vertebral bodies of the lumbar spine. Typically, the ganglion located immediately adjacent to the L2 vertebra is the most common site of injection for this procedure.

Learn More About Radiofrequency Ablation

How Many Treatments Will I Need?

The amount of treatments varies on the severity of the pain and the length of time it has been present.  

When Will I Feel Better?

Nurse looking at screen

After a successful blockade of the sympathetic nervous system there will be an increase in skin temperature most describe as a sensation of warmth coming over the leg on the side of the procedure. This is the indication of a successfully performed sympathetic block. 

After the procedure is completed there are several possible outcomes:

  1. Your pain is improved or even eliminated for several days after the effect of the anesthetic wears off. This indicates the procedure had an obvious therapeutic value and offers some insight into the process causing pain, guiding the future treatment plan to maximize pain control.
  2. There is the sensation of warmth in the leg (evidence of a successful sympathetic blockade), however there is no pain relief. This means the block was successful however the lack of pain relief will be of diagnostic value to your doctor. This will equally guide your physician’s decision making when coming up with future treatment plans.
  3. There is no sensation of warmth in the leg and there is no pain relief. This indicates the block was not performed correctly and may need to be repeated to properly assess whether or not the pain is driven by the sympathetic nervous system.

Is a Lumbar Sympathetic Block Right for Me?

If you suffer from chronic pain that has failed to resolve with medications, physical therapy, and other conservative therapies, this treatment may be an option for you. A lumbar sympathetic block should only be performed under the strict supervision of a board-certified pain management specialist.

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for a lumbar sympathetic block.

Procedure - Patient Details

This treatment is an outpatient procedure in your doctor’s office. A lumbar sympathetic block is typically completed under local anesthesia, although IV sedation can be provided for comfort if needed.

Before starting, monitors will be applied to allow your doctor track your vital signs during the procedure. Once everything is in place, your skin will be cleaned with sterile soap to minimize the risk of infection. The skin and underlying tissue are anesthetized for comfort. The target for this procedure is a small space just in front of the vertebral bodies of the lumbar spine. To properly visualize this space, your physician will use fluoroscopy – a real time X-ray. After the target is identified under fluoroscopy, a small, thin needle is inserted and guided toward the ganglion.

Once the needle tip is in the proper position immediately adjacent to the sympathetic ganglion, a small amount of local anesthetic (Lidocaine or Bupivacaine) is injected. On occasion, your physician may elect to add corticosteroid to the anesthetic to provide added potency.

The entire procedure takes less than 15 minutes. Once the injection is complete, a small dressing will be placed and you will be transferred to the recovery area and monitored to see what effect the procedure had. Many patients will describe a warm sensation come over the leg on the side of the injection, typically followed by pain relief.

Risk Factors

Complications from a lumbar sympathetic block are rare. This procedure is considered to be a safe and appropriate procedure for a variety of different types of pain. Bleeding, infection, nerve damage, and muscle weakness are all possible complications from a lumbar sympathetic block; however, these are easily avoided with proper technique and correct needle placement.

Evidence of Performance

The evidence supporting the use of lumbar sympathetic blocks is overwhelming. Given this procedure was first described for treating pain nearly 100 years ago, it has been well studied and there is no shortage of data supporting its successes.

In 2008, Miles Day published a literature review on sympathetic blocks.[8] He reported there was a “strong recommendation with moderate quality evidence” supporting the use of lumbar sympathetic blocks.

Perhaps the most studied application for sympathetic blocks is in the treatment of CRPS. Meier et al published a study on the treatment of CRPS in children where he reported a clinically relevant improvement in pain as well as a statistically significant reduction in allodynia.[9]  In 2003, Stanton-Hicks developed an algorithm for the treatment of CRPS.[10]  In his report, he described sympathetic blocks as an integral part of the treatment approach and suggested its application early on in its course. Price et al published a study in 1998 praising the diagnostic and therapeutic possibilities of sympathetic blocks and concluded there was a “clinical benefit” to their use on patients with CRPS.[11]

In 2012, physicians from the Cleveland Clinic published a study on the use of sympathetic blocks for the treatment of Diabetic Peripheral Polyneuropathy (DPPN).[12]  The authors not only concluded there was a significant contribution of the SNS to maintenance of pain in DPPN, they established that sympathetic blocks provided sustained and significant pain relief, as well as improved of quality of life over a period of more than two years.

The Ainsworth Institute is Here to Help

If you are suffering from chronic pain that has failed to respond to treatment and would like to see if you may be a candidate for a lumbar sympathetic block, contact the Ainsworth Institute of Pain Management today. Schedule an appointment with one of our Board Certified Physicians to learn more about this exciting treatment option.

References

[1] Hansen HC, Trescot AM, Manchikanti L: Stellate ganglion block. Manchikanti L Singh V Interventional techniques in chronic non-spinal pain. 2009 ASIPP Publishing Paducah, KY 115-140.

[2] Lanz S, Maihöfner C: Symptoms and pathophysiological mechanisms of neuropathic pain syndromes. Nervenarzt. 2009; 80:430-444

[3] Benzon, Honorio. Essentials of Pain Medicine. Philadelphia: Saunders Elsevier, 2011. Print

[4] Stanton-Hicks M, Baron R, Boas R, et al.: Complex regional pain syndromes. guidelines for therapy Clin J Pain. 1998; 14:155-166.

[5] Hashizume K: Herpes zoster and postherpetic neuralgia. Jap J Clin Med. 2001; 59:1738-1742.

[6] Cross F, Cotton L: Chemical lumbar sympathectomy for ischemic rest pain. A randomized, prospective controlled clinical trial. Am J Surg. 1985; 150:341-345.

[7] Elias M: Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000; 3:294-304.

[8] Day M: Sympathetic blocks. the evidence Pain Pract. 2008; 8:98-109.

[9] Meier PM, Zurakowski D, Berde CB: Lumbar sympathetic blockade in children with complex regional pain syndromes. a double blind placebo-controlled crossover trial Anesthesiology. 2009; 111:372-380.

[10] Stanton-Hicks M: Complex regional pain syndrome. Anesthesiol Clin North Am. 2003; 21:733-744.

[11] Price DD, Long S, Wilsey B, et al.: Analysis of peak magnitude and duration of analgesia produced by local anesthetic injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain. 1998; 14:216-218.

[12] Cheng J, Daftari A, Zhou L. Sympathetic blocks provided sustained pain relief in a a patient with refractory painful diabetic neuropathy. Case reports in Anesthesiology. 2012;

 

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