Lumbar Sympathetic Block with Botulinum Toxin Type A and Type B for the Complex Regional Pain Syndrome

Abstract

A lumbar sympathetic ganglion block (LSB) is a therapeutic method for complex regional pain syndrome (CRPS) affecting the lower limbs. Recently, LSB with botulinum toxin type A and B was introduced as a novel method to achieve longer duration of analgesia. In this study, we compared the botulinum toxin type A (BTA) with botulinum toxin type B (BTB) in performing LSB on patients with CRPS. LSB was performed with either BTA or BTB on patients with CRPS in their lower extremities. The length of time taken for patients to return to the pre-LSB pain score and the adverse effect of LSB with BTA/BTB were investigated. The median length of time taken for the patients to return to the pre-LSB pain score was 15 days for the BTA group and 69 days for the BTB group (P = 0.002). Scores on a visual analogue scale decreased in the patients of both groups, and no significant adverse effects were experienced. In conclusion, the administration of either BTA or BTB for LSB is a safe method to prolong the sympathetic blocking effect in patients with CRPS. BTB is more effective than BTA to prolong the sympathetic blocking effect in CRPS patients.

Chemogenetics: Beyond Lesions and Electrodes

“… 81 This is also supported by the fact that sympathetic blocks appear to be efficacious in a subset of patients with CRPS. 82 , 83 With that in mind, a similar approach to palmar and axillary hyperhidrosis could be implemented to modulate sympathetic outflow and manage CRPS. It is important to note that sympathetic blocks are a transient pain relief method, whereas chemogenetic neuromodulation could achieve pain relief every time the synthetic drug is ingested and bound to the DREADD or LGC.…”

Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study

“…However, other imaging techniques such as computerized tomography (CT) [ 39 ], magnetic resonance imaging (MR) [ 40 ] or ultrasound (US) [ 25 , 41 ] have also been described. When the fluoroscopy-guided approached is used, LSBs are often considered correctly performed when there is radioscopically confirmed contrast dye spread, i.e., forming a line conforming to the anterolateral margin of the vertebral bodies [ 25 , 42 ]. However, the variability of contrast spread may be subject to anatomic differences and/or secondary redistribution following injection [ 43 ] and an LSB under radioscopic guidance does not always ensure an exact performance.…”

Effect of botulinum toxin in stellate ganglion for craniofacial hyperhidrosis: a case report

“… 2 Primary hyperhidrosis occurs within families and is a heritable disorder with no other known risk factors. 2 , 3 Secondary hyperhidrosis is caused by medical conditions or medications. Craniofacial hyperhidrosis (CFH) causes emotional and social problems in affected patients.…”

“…Based on this mechanism, BT is often used in sympathetic ganglion blocks because the presynaptic fibers of the sympathetic ganglia are cholinergic. 3 Several studies have demonstrated continued effectiveness of BT injections as sympathetic blocks. 4 , 5 Studies have also shown that direct administration of BT to the sweating site is effective in patients with hyperhidrosis; 6 , 7 however, no studies have shown the effect of BT injection into the stellate sympathetic ganglion.…”