Sympathetic Nerve Blocks: Zeroing in on Complex Regional Pain Syndrome
A growing number of chronic pain sufferers are being diagnosed with Complex Regional Pain Syndrome, or CRPS, a chronic and progressive condition characterized by severe pain, inflammation and changes in the coloring and temperature of the skin. CRPS is believed to be caused by damage or malfunction of the peripheral and central nervous systems, often as a result of injury or trauma to a limb. People afflicted with the condition commonly describe the pain as a burning sensation, which affects one of their arms, legs, hands or feet.
The most common triggers are fractures, strains or sprains, soft tissue injuries (such as cuts, burns, or bruises), or limb immobilization (such as being in a cast).
As with any chronic pain, CRPS can significantly affect an individual’s quality of life, keeping them from the simplest of activities and affecting their sleep patterns and mood.
“Zeroing in on the cause of chronic pain is half the battle,” says Faisal Motlani, MD, a board certified anesthesiologist at the Centre for Pain Care (CPC) in Toronto. “Because CRPS remains an elusive diagnosis, individuals experiencing this type of chronic pain sometimes suffer for years without a full understanding of the underlying pathology,” says Dr. Motlani. But with today’s technology, there are diagnostic and treatment options for CRPS sufferers.
Today, pain management specialists at the CPC are utilizing sympathetic nerve blocks to diagnose the condition, with some patients realizing an additional benefit to the procedure – temporary pain relief. A sympathetic nerve block is a highly specialized procedure that helps to pinpoint the affected nerves and blocks pain signals to the brain. Sympathetic nerve blocks involve injecting an anesthetic near a collection of nerves to directly inhibit nerve transmission and improve blood flow.
The sympathetic nerves are distributed as networks in various parts of the body. In the case of the lumbar sympathetic chain, the nerves are found along the front and lateral side of the spinal column. The stellate ganglion is a confluence of sympathetic nerves located anterior to the cervical spine. They are part of the autonomic nervous system and control many basic bodily functions including sweating, heart rate, digestion, and blood pressure. “The sympathetic nerves can modulate pain transmission from the peripheral tissues into the spinal cord,” says Dr. Motlani. “In certain conditions like CRPS, pain receptors may become abnormally responsive to sympathetic nervous system messengers.” “It is also theorized that there may be an abnormal immune response leading to the inflammatory symptoms seen in CRPS.”
“The sympathetic nerve block helps to identify if this part of the nervous system is modulating the pain transmission, and can, in turn, reduce pain and swelling and improve mobility,” said Dr. Motlani. The physicians at the CPC perform many procedures, including sympathetic nerve blocks, under x-ray or ultrasound. “Image-guided procedures are more accurate, thereby allowing maximal benefit,” says Dr. Motlani. “The use of imaging also increases the safety of the intervention and minimizes discomfort as there is less needle manipulation.”
As with any procedure of this type, results vary from patient to patient. “There is no known cure for chronic pain stemming from CRPS, but there are potential treatments that can help sufferers live a normal life without pain every second of the day,” says Dr. Motlani.
Dr. Faisal Motlani is board certified in anesthesiology by the American Board of Anesthesiology and licensed in spinal cord stimulation and invasive pain management techniques. He is a member of the American Society of Interventional Pain Physicians, the American Society of Anesthesiologists, and the American Society of Regional Anesthesia and Pain Management.
The Centre for Pain Care is a Toronto-based medical treatment centre specializing in the management and treatment of chronic pain of the head, neck, face and back. Our caring doctors specialize in interventional treatments and minimally invasive techniques that can offer healing relief to patients suffering from everything from chronic headaches to degenerative joint disease. We offer advanced solutions to achieve the best outcomes for chronic pain patients so that they can live healthier, happier and more successful lives.