7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Sympathetic Nerve Block

 

What it is used to treat?

 

Sympathetic nerve blocks are used in the treatment of chronic pain related to complex regional pain syndrome, also called reflex sympathetic dystrophy, as well as trigeminal neuralgia/tic del a roux, and chronic abdominal pain.  Other possible uses include any type of neuropathic/nerve related pain including shingles, nerve injury, neuropathy etc.

 

What the goal/purpose?

 

The goal is to stop the cycle of neuropathic or nerve-maintained pain.  Sometimes repeatedly blocking the nerves involved can lead to decreased pain.  Sometimes the block is only diagnostic, and a pulsed radiofrequency ablation needs to be performed.

 

In cases of complex regional pain syndrome, the block is used to allow for the start of desensitization exercises- these need to be started within a few hours of the block and can either be done at home or may require coordination with your physical therapist.

 

Sometimes the block itself is enough to make improvement.  Sometimes the block only results in temporary improvement.

 

What should I do to get ready for the procedure?

 

Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol.   Read the list of medications that must be stopped that was given to you at your office visit.  Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke.  It is your responsibility to clear this with your doctor.

 

Continue to take your other medications.  Do not stop blood pressure or diabetes medicines.

 

Do not eat or drink anything on the morning of your procedure.  You may eat and drink afterward.

 

How is it done?

 

Patients position themselves on the procedure table.  Monitors are attached to keep track of your vital signs during the procedure.  The area over the procedure site is prepped and draped in a sterile manner to protect against infection.  A fluoroscopic x-ray is then used to locate the target site.  The skin is numbed with lidocaine and a needle is advanced toward the target under x-ray guidance.

 

It is very important on the days of the block that you have pain when we do the test.  If you happen to wake up with no pain on test day, simply call and reschedule.

 

 

After the block, you must stay awake for several hours to see if you received relief.  We suggest going out to breakfast after the test and then doing activities that would normally not be possible.  Please call us 4-6 hours after the test and report your results.

 

If we are treating CRPS/RSD, it is important that you begin desensitization exercises within a short time of receiving the block

 

What is injected?

 

Lidocaine to numb the skin and either lidocaine or ropivacaine to block the nerve.  Depending on the site, dexamethasone may also be used, as well as a radiocontrast agent such as Omnipaque or Isovue or others

 

Will it hurt?

 

These procedures can be uncomfortable, and most patients opt for sedation.  You do not have to take sedation if you do not want it.  There is some discomfort associated with numbing the skin, and there may be pressure during the injection.  Some patients require some sedation for the procedure, and others do not. The vast majority of patients tell us ‘that wasn’t so bad” or “I can’t believe I was worried about that;” however some people do find it painful and may require sedation.

 

Important Warning!

 

You may have some pain at the injection site- this is normal.  Some bruising may be present as well.

 

If you had a block for facial pain, your eye on the side of the block may appear bloodshot and droopy for a few hours.  Also you may have difficulty swallowing for several hours, so be very careful when eating or drinking.

 

After treatment for abdominal pain, it is common to have some dizziness when first standing up and possibly diarrhea.

 

Some difficulty urinating or with sexual performance can occur.

 

What is the chance of success?

 

Approximately 75% of our patients get significant relief from this type of procedure.

 

How often can the procedure be repeated?

 

In cases of sympathetically maintained pain the injection may have to be repeated several times over the course of a few weeks.  Usually if the blocks do not last very long we will move on to a pulsed radiofrequency ablation (link).  These may need to be repeated every 6-10 months until the problem resolves or until the procedures cease to be effective

 

What can I do to maximize my chance of success?

 

Do your desensitization exercises regularly.  Avoid triggers of your pain such as exposure to cold etc.  Take your medications as prescribed.

 

Why do I have a blue towel in my pants/shirt on my face?

 

We place a sterile towel over the injections sites to absorb any mild bleeding.

 

Why are there EKG pads still in place?

 

If you have thin skin or hair in the area, we may leave the EKG pads in place so that you can gently remove them with soap and water at home.

 

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