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Overview

This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a common treatment for shingles and complex regional pain syndromes affecting the lower back and legs, feet and joints of the lower extremities, and help increase blood flow to the lower extremities’ due to neuropathy. Usually a series of these injections is needed to treat the problem.

Indications

This procedure is indicated for use with pain conditions caused from complex regional pain syndromes of the lower extremity, peripheral neuropathy, RSD of the lower extremity, pelvic type pain, shingles in the mid thoracic, lumbar and lower extremity region, and some sympathetic nerve mediated pain syndromes of the thoracic and lumbar areas area. For sympathetic pain from the pelvic area, the lower ganglion may need to be blocked in the L5 and sacral areas or even in the coccyx area.

What to Expect

The patient will be face down under the fluoroscopy (x-ray) with a cushion under their abdomen in order to arch the back in a ‘mad cat’ type of position. This brings the lower lumbar ganglion area closer to the surface. The operator will feel and identify the muscles of the lumbar spine after injection local of anesthesia in the skin to numb the area first. Using the x-ray guidance, a needle will be placed through the numb skin and down to the lumbar ganglion on the anterior surface of the bone. Contrast can be used to identify proper placement and then injection of local long lasting anesthetic and steroid medications can be done in small intermittent doses while keeping contact with the patient.

Outcomes

Some patients get immediate relief of the pain and most will experience a change over time for a longer lasting relief and return to less painful state. Warmth increase in a cold extremity can be seen as well. The reflex of pain producing decreased blood flow can be broken with repeated blocks. The pain may recur in hopefully a lower intensity level and the injection may need to be repeated in a series of injections. The procedure can be used to both diagnosis and treat peripheral neuropathy and it may also be used to indicate if the patient is a candidate for a lumbar spinal cord stimulator trial.