Continuous Thoracic Sympathetic Ganglion Block in Complex Regional Pain Syndrome Patients with Spinal Cord Stimulation Implantation

Abstract

The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS). However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS). In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB) has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia. We administered continuous thoracic sympathetic block using catheter in CRPS patients who underwent SCS implantations and achieved desirable outcomes. We believe a continuous sympathetic block is a considerable option before performing neurolysis or radiofrequency rhizotomy and even after SCS implantation.

Comparison of efficacy of continuous epidural block and pulsed radiofrequency to the dorsal root ganglion for management of pain persisting beyond the acute phase of herpes zoster

“…Continuous epidural block is often used in clinical practice in cases where pain is refractory to conservative treatment. The usefulness of repetitive epidural block using an indwelling catheter in acute herpes zoster has been reported [ 6 ], as well as the long-term effects of continuous nerve block with local anesthetic infusion for chronic neuropathic conditions such as complex regional pain syndrome (CRPS) or PHN [ 12 , 13 ]. Repetitive infusion of local anesthetics into the paravertebral space in PHN has also been reported to be effective [ 14 ].…”

Spinal cord stimulation in the treatment of neuropathic pain: Current perspectives of indications, cost-effectiveness, complications and results

“…In terms of the neuropathic pain etiology, SCS has been applied in the treatment of deafferentation pain, central pain, phantom limb pain (PLP), causalgia, myelopathy, oncologic pain, lumbosacral fibrosis, postherpetic neuralgia (PHN), FBSS, CRPS, reflex sympathetic dystrophy (RSD), spinal cord, brainstem or brain injury, and others (3,(13)(14)(15)22,32,33,38,42,43,(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57).…”

“…These include rhizotomy, sympathectomy, cordotomy, hypophysectomy, regional infusion of sympatholytic infiltrations, and intrathecal administration of drugs. Recently, electrical stimulation therapies such as spinal cord stimulation (SCS), motor cortex stimulation, and deep brain stimulation have been described (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Spinal cord stimulation in pregnant patients: Current perspectives of indications, complications, and results in pain control: A systematic review

“…Nonpregnant and pregnant patients affected by CRPS and FBSS have demonstrated significant rates of success in pain control associated to a low rate of complications although the total pain control rarely was obtained through the use of SCS individually as therapy [Tables 3 and 4, adapted from Camporeze et al , 2017. [18282930313233343536373839404142434445464748495051] Furthermore, this procedure has been described associated to a significant cost-effectiveness rates when compared the conventional pharmacological pain management. [1852535455565758]…”