Pediatric Complex Regional Pain Syndrome: Stellate Ganglion and Lumbar Sympathetic Blocks

2021 ◽  
pp. 167-174
Author(s):  
Sarah Choxi
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Early Recognition ◽  
Multidisciplinary Treatment ◽  
Stellate Ganglion ◽  
Pain Syndrome ◽  
Signs And Symptoms ◽  
Nerve Blocks ◽  
Distal Extremity ◽  
Peripheral Nerve Blockade ◽  
Sympathetic Blocks

Complex regional pain syndrome (CRPS) is a chronic, localized pain condition following an injury, typically affecting a distal extremity. Although the pathophysiology of CRPS is unclear, multiple mechanisms are implicated, including peripheral and central sensitization as well as sympathetically mediated pain. Peripheral nerve blockade can treat the somatic component of CRPS pain, while sympathetic blockade may alleviate pain that is sympathetically mediated. Signs and symptoms manifest as abnormal sensory, motor, vasomotor, and sudomotor changes that are disproportionate to the inciting event. Early recognition of the signs and symptoms, followed by rapid implementation of a multidisciplinary treatment approach—including physical therapy, psychotherapy, pharmacotherapy, and sympathetic nerve blocks, is a major factor in improving outcome and preventing treatment-resistant CRPS.

Sympathetic blocks for complex regional pain syndrome: a survey of pain physicians

2019 ◽  
Vol 44 (7) ◽  
pp. 736-741 ◽  
Author(s):  
Xiaoying Zhu ◽  
Lynn R Kohan ◽  
Joshua D Morris ◽  
Robin J Hamill-Ruth
Keyword(s):  
Best Practices ◽  
Complex Regional Pain Syndrome ◽  
Current Practice ◽  
Stellate Ganglion ◽  
Pain Syndrome ◽  
Clinic Visit ◽  
Vertebral Level ◽  
Evidence Based Guidelines ◽  
Sympathetic Blocks ◽  
Question Survey

BackgroundSympathetic blocks (SB) are commonly used to treat pain from complex regional pain syndrome (CRPS). However, there are currently no guidelines to assist pain physicians in determining the best practices when using and performing these procedures.MethodsA 32-question survey was developed on how SBs are used and performed to treat CRPS. The survey was conducted online via SurveyMonkey. The responses were statistically analyzed using descriptive statistics, and comparing academic versus non-academic, and fellowship versus non-fellowship-trained physicians.ResultsA total of 248 pain physicians responded with a response rate of 37%. Forty-four percent of respondents schedule the first SB at the first clinic visit; 73% perform one to three consecutive blocks; over 50% will repeat the block if a patient receives at least 50% pain relief from the previous one lasting 1–7 days.Fifty-four percent of respondents perform stellate ganglion blocks (SGB) at the C6 vertebral level, 41% at C7; 53% perform lumbar sympathetic blocks (LSB) at L3 level, 39% at L2; 50% use fluoroscopy to guide SGB, 47% use ultrasound. More respondents from academic than non-academic centers use ultrasound for SGB. About 75% of respondents use a total volume of 5–10 mL for SGB and 10–20 mL for LSB. The most commonly used local anesthetic is 0.25% bupivacaine. About 50% of respondents add other medications, mostly steroids, for these blocks.ConclusionOur study showed a wide variation in current practice among pain physicians in treating CRPS with SBs. There is a clear need for evidence-based guidelines on when and how to perform SBs for CRPS.

Complex Regional Pain Syndrome

2019 ◽  
pp. 262-270
Author(s):  
Steven R. Hanling ◽  
Ian M. Fowler ◽  
C. Ryan Phillips
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Signs And Symptoms ◽  
Pain Medication ◽  
Channel Blockers ◽  
Chronic Pain Condition ◽  
Ion Channel Blockers ◽  
Budapest Criteria ◽  
Sympathetic Blocks

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically occurs after injury to a limb or directly to a nerve. Progression of the disease can result in multiple debilitating symptoms including pain disproportionate to the inciting event. The Budapest criteria cateforize the constellation of signs and symptoms of CRPS (sensory, vasomotor, sudomotor/edema, and motor/trophic changes) and are used to diagnose the syndrome. Treatments include rehabilitation (physical and occupation therapy), multimodal pain medication (medications that target neuropathic pain such as antidepressants, membrane stabilizers, and ion channel blockers), interventional treatments (sympathetic blocks, infusion catheters, neuromodulation), and psychological therapy.

Complex Regional Pain Syndrome

2018 ◽  
pp. 295-308
Author(s):  
Brian A. Kim ◽  
Timothy Furnish
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Multimodal Treatment ◽  
Pain Syndrome ◽  
Signs And Symptoms ◽  
Burning Pain ◽  
Patient Responsiveness ◽  
Common Clinical Finding ◽  
Interventional Therapies ◽  
Sympathetic Blocks

Complex regional pain syndrome (CRPS) is a challenging pain condition with incompletely elucidated pathophysiology, most often affecting a single extremity after an inciting injury. The most common clinical finding is burning pain out of proportion to any identifiable initiating event, with a combination of sensory, vasomotor, sudomotor, and motor/trophic signs and symptoms. The management of CRPS emphasizes early diagnosis and aggressive multimodal treatment based on physical therapy, psychological therapy, and pain management with frequent reassessments of patient progression. In order to prevent permanent life-altering disability, all modalities including interventional therapies should be escalated in tandem, based on assessments of patient responsiveness. Clinicians should consider escalating therapy frequently if no improvement is observed, and introducing psychological evaluation if symptoms persist. Lastly, the use of interventional techniques such as sympathetic blocks or spinal cord stimulation should be employed early in refractory cases.

scholarly journals Venipuncture-Induced Complex Regional Pain Syndrome: A Case Report and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Foad Elahi ◽  
Chandan G. Reddy
Keyword(s):  
Neuropathic Pain ◽  
Pain Management ◽  
Complex Regional Pain Syndrome ◽  
Upper Extremity ◽  
Early Recognition ◽  
Multidisciplinary Treatment ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Medical Procedure ◽  
Chronic Neuropathic Pain

Venipuncture, the most frequently performed invasive medical procedure, is usually benign. Generally it produces only transitory mild discomfort. Venipuncture-induced neuropathic pain is hard to recognize at an early stage. Medical literature reviews show that there is not adequate medical knowledge about this important subject. The inciting incident in complex regional pain syndrome (CRPS) can often seem far too trivial to result in a condition with such severe pathophysiologic effects. The practicing physician has little information available to enable early recognition of the condition, initiation of multidisciplinary treatment modalities, and proper referral to pain specialists. We encountered a unique case of venipuncture-induced complex regional pain syndrome (CRPS). The patient is a 52-year-old school teacher with no significant past medical history, who presented initially to the Center of Pain Medicine with left upper extremity pain. The pain started while phlebotomy was performed in the patient’s left antecubital area for routine blood check. The patient’s pain did not improve with multiple medications, physical therapy, or several nerve blocks. The patient demonstrated all the signs and symptoms of chronic neuropathic pain of CRPS in the upper extremity with minimal response to the continuous pain management. We decided to proceed with cervical spinal cord nerve stimulation along with continuing other modalities. The patient responded to this combination. During the follow-up, we noticed that the patient’s pain course was complicated by extension of the CRPS to her lower extremity. We will describe the course of treatment for the patient in this paper. In this paper we will discuss the electrical neuromodulation as an important modality in addition to the multidisciplinary pain management for a patient with venipuncture-induced chronic neuropathic pain.

scholarly journals Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021 ◽  
pp. 213-217
Keyword(s):  
Case Report ◽  
Complex Regional Pain Syndrome ◽  
Nerve Root ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Nerve Root Injury ◽  
Epidural Steroid

BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

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