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Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome
K Demey1, S Nijs2, W Coosemans3
1Department of General Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. demeykarel@hotmail.com.
Summary
Endoscopic thoracic sympathectomy (ETS) significantly reduces pain and disability in patients with posttraumatic complex regional pain syndrome (CRPS). This effective treatment improves quality of life and should be considered for CRPS management.
Area of Science:
- Pain Medicine
- Surgical Interventions
- Neurology
Background:
- Posttraumatic complex regional pain syndrome (CRPS) severely impairs rehabilitation and daily activities.
- Current treatments for CRPS are often ineffective, highlighting the need for alternative therapeutic options.
Purpose of the Study:
- To prospectively evaluate the efficacy of endoscopic thoracic sympathectomy (ETS) in alleviating pain and disability associated with CRPS.
Main Methods:
- A cohort of 12 patients with posttraumatic CRPS underwent unilateral ETS, involving resection of the sympathetic chain (T2-T5) and severing the nerve of Kuntz.
- Pain was assessed using a visual analogue scale (VAS) for both passive (rest) and active (movement) pain.
- Follow-up extended up to 40 months post-surgery, with assessments at 1, 2, 6, and 12 months.
Main Results:
- Significant reductions in both passive and active VAS pain scores were observed at all follow-up intervals (P < 0.05).
- 83% of patients required fewer analgesics post-ETS, with 67% becoming completely pain-medication-free.
- Median sleep duration improved significantly from 2 hours pre-operatively to 6.25 hours post-operatively (P < 0.001), and overall patient satisfaction was 83%.
Conclusions:
- Endoscopic thoracic sympathectomy (ETS) demonstrates significant effectiveness in reducing pain and enhancing the quality of life for patients suffering from CRPS.
- ETS is a viable and recommended treatment option for managing complex regional pain syndrome.
