Cervical (Stellate) and Lumbar Sympathetic Blocks
1. What are the sympathetic nerves?
The sympathetic nerves are a group of nerves that run in front of the spinal column. They are part of the autonomic nervous system and control many types of bodily functions such as sweating, blood pressure and digestion. Occasionally, these nerves can be injured causing pain. This can result in a condition known as Complex Regional Pain Syndrome or CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy. Sometimes the injury can be minor such as a sprain. Other causes of sympathetically mediated pain include Herpes Zoster or Shingles, Raynaud’s Disease, Phantom Limb Pain, Cancer, frostbite or other vascular problems.
2. How do I know if the sympathetic nerves are the cause of my pain?
Only your doctor or pain specialist can tell. Pain from a problem in the sympathetic nervous system can be confined to an arm or leg or develop to include several body areas. The symptoms of a problem with the sympathetic nerves can be pain, which can be described as "burning" in nature. Sometimes, there is increased or decreased temperature in the affected area. The area can initially have increased sweating or a change in the hair or nails. Your doctor will examine you to determine whether the cause of your pain may be related to the sympathetic nerves. He may order a triple phase bone scan to see if your pain may be sympathetically mediated. Often he may suggest a diagnostic procedure, which involves placing a local anesthetic such as novocaine in or near the area of the spine that controls the sympathetic nerves. If, after the injection, the pain disappears or lessens then the sympathetic nerves may be a cause of your pain.
3. How is Complex Regional Pain Syndrome (CRPS) or RSD treated?
Initially, conservative treatment is prescribed. This consists of rest, medications and physical therapy. If this is not successful, an injection into the area of the sympathetic nerves may help. A pain specialist does this, usually an anesthesiologist. The Stellate Ganglion is the name of the group of sympathetic nerves which control the arm and upper body. The group of nerves that control the leg and foot is the Lumbar Sympathetic Chain.
4. How is the injection done?
First, you will have a consultation with the pain specialist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. You must have someone with you after the procedure to drive you home. The injection is usually quick, only several minutes for each side. A small amount of sedation is given intravenously to decrease anxiety. Monitors will be placed to watch your blood pressure, heart rate and blood oxygen. The skin is numbed with a small amount of local anesthetic (lidocaine or bupivicaine). Once the numbing medication is given, there is little or no pain during the injection. The needle is placed in the area and the medication is then given. You will have a brief recovery and will then be discharged home with your driver.
5. What should I expect after the procedure?
Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain may return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.
6. How many injections do I need?
You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, additional injections may then be given. If the injections do not relieve your pain, then the source of the discomfort may not be the sympathetic nerves.
7. What are the risks of the injection?
Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site. Sometimes, the medication may spread outside the intended area of injection and you may experience mild numbness in an arm or leg. The injection for the Stellate Ganglion is often followed by temporary problems with swallowing and drooping of the eyelid which are expected and should wear off in several hours.
8. Should I get the injection?
That decision can only be made after you see the pain specialist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a problem in the sympathetic nervous system, complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy (RSD). is the likely source of your problem and if you are a candidate for the procedure.