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Sympathectomy for neuropathic pain.
1Department of Medicine, Comprehensive Pain Program, 399 Bathurst Street, Fell Pavillion 4B-174, Toronto, Ontario, Canada, M5T 2S8. angela.mailis@uhn.on.ca
The Cochrane Database of Systematic Reviews
|June 14, 2003
Summary
Surgical and chemical sympathectomy for neuropathic pain is supported by low-quality evidence and may lead to significant complications. Further clinical trials are needed to determine the true effectiveness and risks of these procedures.
Area of Science:
- Neurology
- Pain Management
- Surgical Interventions
Background:
- Neuropathic pain arises from nervous system lesions or dysfunction.
- Conditions include phantom limb pain, post-stroke pain, and complex regional pain syndromes.
- Historically, sympathectomy aimed to interrupt the sympathetic nervous system for pain relief.
Purpose of the Study:
- To assess the efficacy of chemical and surgical sympathectomy for neuropathic pain.
- To compare sympathectomy outcomes against no treatment, placebo, or conventional therapies.
- To evaluate the influence of specific sympathectomy techniques on procedural outcomes.
Main Methods:
- Searched MEDLINE, EMBASE, and Cochrane Library up to February 2003.
- Included clinical trials and observational studies on sympathectomy for neuropathic pain.
- Narrative synthesis was performed due to data heterogeneity; statistical pooling was not possible.
Main Results:
- Four studies were included; one randomized trial was of low methodological quality.
- Radiofrequency sympatholysis showed no advantage over phenol sympathectomy.
- A modified technique yielded comparable sympatholysis to phenol with fewer complications.
Conclusions:
- Current practice of sympathectomy relies on weak evidence and uncontrolled studies.
- Complications include pain exacerbation, new pain syndromes, and abnormal sweating.
- More high-quality clinical trials are essential to establish effectiveness and risks.