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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 head, face, neck, and arms. It can help treat and increase pain control of low blood flow states caused by neuropathy of the upper extremities. 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 upper extremity, peripheral neuropathy, RSD of the upper extremity, facial pain, shingles in the head, face neck and shoulder region, and some sympathetic nerve mediated pain syndromes of the thoracic area.

What to Expect

The patient will be face up under the fluoroscopy (xray) with a cushion under their shoulders in order to arch the neck in ‘hanging head over the edge’ type of position. This brings the lower stellate ganglion area closer to the surface. The operator will feel and pull the muscles out of the way after injection local 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 stellate ganglion of the upper 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 level and the injection may need to be repeated in a seris of injecitons. 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 cervical spinal cord stimulator trial.