Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: A double-blind randomized controlled study

Abstract

Pain relief in complex regional pain syndrome (CRPS) remains a major challenge, in part due to the lack of evidence-based treatment trials specific for this condition. We performed a long-term randomized, double-blinded active-control study to evaluate the efficacy of thoracic sympathetic block (TSB) for upper limb type I CRPS. The study objective was to evaluate the analgesic effect of TSB in CRPS. Patients with CRPS type I were treated with standardized pharmacological and physical therapy and were randomized to either TSB or control procedure as an add-on treatment. Clinical data, pain intensity, and interference (Brief Pain Inventory), pain dimensions (McGill Pain Questionnaire [MPQ]), neuropathic characteristics (Neuropathic Pain Symptom Inventory [NPSI]), mood, upper limb function (Disabilities of Arm, Shoulder and Hand), and quality of life were assessed before, and at 1 month and 12 months after the procedure. Thirty-six patients (19 female, 44.7 ± 11.1 years of age) underwent the procedure (17 in the TSB group). Average pain intensity at 1 month was not significantly different after TSB (3.5 ± 3.2) compared to control procedure (4.8 ± 2.7; P=0.249). At 12 months, however, the average pain item was significantly lower in the TSB group (3.47 ± 3.5) compared to the control group (5.86 ± 2.9; P=0.046). Scores from the MPQ, evoked-pain symptoms subscores (NPSI), and depression scores (Hospital Anxiety and Depression Scale) were significantly lower in the TSB group compared to the control group at 1 and at 12 months. Other measurements were not influenced by the treatment. Quality of life was only slightly improved by TSB. No major adverse events occurred. Larger, multicentric trials should be performed to confirm these original findings.

Complex regional pain syndrome: a recent update

“…Sympathetic blocks aim to alleviate the sympathetically mediated pain and can be used in combination with botulinum toxin to prolong the duration of analgesia. Recent evidence has shown sympathetic blockade to provide substantial pain reduction as well as longer analgesic duration, which enable patients to improve participation in functional therapies [97–99]. However, there remains a lack of definitive evidence regarding the efficacy of sympathetic blockade overall, and this approach has yet to be shown to be curative [100].…”

Sympathetic blocks for the treatment of complex regional pain syndrome

“…[ 5 – 7 ] One randomized, double-blind active-control study investigated the efficacy of thoracic sympathetic blocks (TSB) for upper limb CRPS type-1. [ 8 ] At 12 months, the average pain scores were significantly lower in the TSB group (3.47 ± 3.5) compared to the control group (5.86 ± 2.9; P = .046). [ 8 ] Also noteworthy is that the scores from the McGill Pain Questionnaire (MPQ), Neuropathic Pain Symptom Inventory (NPSI), and Hospital Anxiety and Depression Scale (HADS) were significantly lower in the TSB group compared to the control group at 1 and at 12 months.…”

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

“…From the early 20th century, the sympathetic block has been used in CRPS treatment [ 12 ], and its effects to various extents have been reported with inconsistent level of evidence [ 3 , 13 ]. However, in a recent randomized controlled study, TSGB showed short- and long-term positive effects during the treatment of CRPS in upper extremities [ 14 ].…”