Stellate ganglion pulsed radiofrequency ablation for stretch induced complex regional pain syndrome type II

Abstract

Complex regional pain syndrome (CRPS) following injury or nerve damage, as its name signifies, is a challenging entity, and its successful management requires a multidisciplinary approach. It not only manifests as severe pain, but also gives rise to functional disability, lack of sleep, lack of enjoyment of life and poor quality of life. Various pain interventional techniques have been described in the literature for the management of CRPS ranging from sympathetic blocks to spinal cord stimulator. A 34-year-old liver transplant donor, who developed position-induced right upper limb neuropathic pain suggestive of CRPS type II was managed initially with medications and later with stellate ganglion block under fluoroscopic guidance at cervical C7 position. Following an initial significant improvement in pain and allodynia, which was transient, a pulsed radiofrequency ablation of stellate ganglion was performed successfully to provide prolonged and sustained pain relief, which persisted up to 14 months of follow-up.

Thermal Versus Super Voltage Pulsed Radiofrequency of Stellate Ganglion in PostMastectomy Neuropathic Pain Syndrome: A Prospective Randomized Trial

“…Recently, a case report of CRPS-II of the upper arm showed excellent pain relief for 2 months following pulsed RF of stellate ganglion (48). Our protocol design specified pulsed RF technique with duration of 6 minutes which is the least time for pulsed RF to exert its anti-allodynic action in neuropathic disorders (29).We also tried the high (super) voltage method by adjusting the manual mode of the Baylis generator at 60-70 volt assuming to augment the pain-relieving effect of pulsed RF (30).…”

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article

“…These studies (excluding case series and reports) are summarized in Tables 1, 2, 3, 4, and 5. Studies involving RF treatment of the SNS primarily focused on its efficacy in CRPS (Table 1) [28][29][30][31][32][33][34][35][36], pain in the perineal region (Table 2) [37][38][39][40][41][42][43][44][45][46][47][48], headache and facial pain (Table 3) [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63], and oncologic and non-oncologic abdominal pain (Table 4) [64][65][66][67][68][69][70][71]…”

“…levels for lower extremity CRPS[28][29][30][31] and either thoracic sympathetic ganglia at the T2 and T3 vertebral levels or the stellate ganglion for upper extremity CRPS[32][33][34][35][36]. Earlier studies included in this review investigated the use of CRF in CRPS, which transitioned to PRF more recently.…”

“…Additionally, most focused primarily on CRPS I. However, Rana et al successfully applied PRF to the stellate ganglia in in a patient with CRPS II[32].The evidence for CRF vs. chemical neurolysis for the treatment of lower extremity CRPS is unclear. While Haynsworth et al reported significant superiority of sympathetic blockade with chemical neurolysis 8 weeks post-procedure (89% vs. 12% with CRF)[28], Manjunath et al reported similar successes in pain reduction with both options across 4 weeks postprocedure…”

Pulsed radiofrequency ablation of stellate ganglion for chronic facial pain

“…The anatomical location of stellate ganglion varies, and therefore three lesions were done with two cycles of current at each location. [ 6 ]…”