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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
Published on: January 10, 2019
Chemical sympathectomy for neuropathic pain: does it work? Case report and systematic literature review
A D Furlan1, P W Lui, A Mailis
1Comprehensive Pain Program, The Toronto Western Hospital, and Institute for Work & Health, Ontario, Canada.
Objective:
To determine if chemical sympathectomy successfully reduces limb neuropathic pain.
Design:
Systematic literature review of the effectiveness of phenol or alcohol sympathectomy for extremity neuropathic pain.
Patient:
A 29-year-old female with complex regional pain syndrome of both lower extremities after back surgery who was submitted to bilateral lumbar chemical sympathectomy.
Search Strategy:
The Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, Medline, and EMBASE were systematically searched.
Outcome Measures:
(1) For the patient in question: spontaneous pain, allodynia, pinprick hyperalgesia, pressure evoked pain; (2) For the literature review: meaningful versus nonmeaningful pain relief based on degree and duration (>2 weeks) of pain relief.
Results:
(1) The case reported experienced partial temporary relief of pain primarily related to selective modulation of allodynia, but not deep pain or pinprick hyperalgesia; (2) 44% of 66 patients in 13 studies that met the authors' inclusion criteria experienced meaningful pain relief. Whereas 19% experienced no meaningful relief, for the remaining 37% of the patients no conclusions regarding duration and degree of relief could be drawn due to poor reporting of outcomes.
Conclusions:
Based on the case reported and systematic literature review, chemical sympathectomy seems to have at best a temporary effect, limited to cutaneous allodynia. Despite the popularity of chemical sympatholysis, only few patients and poorly defined outcomes are reported in the literature, substantiating the need for well-designed studies on the effectiveness of the procedure.
