Sympathetic Nerve & Visceral Pain Interventions

The sympathetic nervous system may be involved in specific pain syndromes. These include complex regional pain syndrome (formerly called reflex sympathetic dystrophy or RSD), atypical facial pain and microvascular ischemia. Local anesthetic injected around the sympathetic ganglia in the cervical or lumbar spine may diagnose sympathetic involvement in painful conditions of the head/neck/upper extremities and the lower extremities, respectively. These procedures require the use of X-ray at a surgery center in order to provide accurate needle placement and treatment of potential side-effects. The patient is evaluated immediately after such injections in order to determine the effect of the local anesthetic.​

For certain conditions, repeated sympathetic nerve blocks combined with aggressive physical therapy can result in symptom resolution.​

For recalcitrant conditions, long-term block of the sympathetic nervous system can be obtained by radiofrequency neuroablation or spinal cord stimulation.

Additionally, abdominal and pelvic pain is mediated by nerves that coalesce with specific ganglia near the lumbar spine. The well-defined location of these ganglia allow for interventions designed to alleviate chronic abdominal or pelvic pain.

Abdominal pain may be treated with a celiac plexus axis intervention. The celiac plexus is located just anterior to the aorta at the L1 vertebral level. For malignant pain such as pancreatic, stomach or liver cancer, this intervention may consist of the precise injection of alcohol which destroys the nerves that mediate pain. This is a precise injection that requires X-ray localization and intense post-procedure monitoring and treatment of side-effects. Prior to the neurolytic block, a diagnostic block with local anesthetic is usually performed in order to demonstrate efficacy of the technique and lack of serious complications. For benign pain conditions that demonstrate short-term improvement with local anesthetic celiac plexus block, radiofrequency neuroablation of the bilateral greater and lesser splanchnic nerves may be performed. This splanchnic nerve procedure may be repeated indefinitely, typically at six to twenty-four month intervals.

Pelvic pain is mediated through the superior hypgastric plexus which is located anterior the spine at the L5-S1 vertebral level. Again, this injection requires X-ray guidance as well as a diagnostic block with local anesthetic prior to using alcohol for neuroablation. Because this procedure may have negative side-effects involving bowel and bladder function, the neurolytic procedure is usually limited to malignancies involving the pelvic organs.