Sympathetic Blocks Provided Sustained Pain Relief in a Patient with Refractory Painful Diabetic Neuropathy

Abstract

The sympathetic nervous system has been implicated in pain associated with painful diabetic neuropathy. However, therapeutic intervention targeted at the sympathetic nervous system has not been established. We thus tested the hypothesis that sympathetic nerve blocks significantly reduce pain in a patient with painful diabetic neuropathy who has failed multiple pharmacological treatments. The diagnosis of small fiber sensory neuropathy was based on clinical presentations and confirmed by skin biopsies. A series of 9 lumbar sympathetic blocks over a 26-month period provided sustained pain relief in his legs. Additional thoracic paravertebral blocks further provided control of the pain in the trunk which can occasionally be seen in severe diabetic neuropathy cases, consequent to extensive involvement of the intercostal nerves. These blocks provided sustained and significant pain relief and improvement of quality of life over a period of more than two years. We thus provided the first clinical evidence supporting the notion that sympathetic nervous system plays a critical role in painful diabetic neuropathy and sympathetic blocks can be an effective management modality of painful diabetic neuropathy. We concluded that the sympathetic nervous system is a valuable therapeutic target of pharmacological and interventional modalities of treatments in painful diabetic neuropathy patients.

Continuous Lumbar Sympathetic Blockade Enhances the Effect of Lumbar Sympatholysis on Refractory Diabetic Neuropathy: A Randomized Controlled Trial

“…It has consistently been shown that the administration of dexamethasone can prolong analgesia after peripheral nerve block [ 21 ]. One case report showed that the use of a mixture of lidocaine and triamcinolone in a lumbar sympathetic block was able to significantly reduce the pain scores of the patient with painful diabetic neuropathy [ 11 ]. It has also been suggested that damaged nerve fibers often have dysregulated expression of sodium channels that are particularly sensitive to local anesthetics, such as lidocaine [ 22 ].…”

“…Improvement of the peripheral blood flow may be involved in the mechanism of the analgesic effect of spinal cord stimulation. In China, spinal cord stimulation for treating neuropathic pain is not in wide use due to the high cost of the treatment; as alternative, another non-pharmacological approach, lumbar sympathetic blockade, has received much interest [ 11 ]. Lumbar sympathetic blockade has the advantage of being a minimally invasive technique, with patients usually having a quick recovery time.…”

“…Although the technique has been available for a long time, its safety and outcomes in patients with painful diabetic peripheral neuropathy have not been intensively studied. One case report suggested that sympathetic blocks can be an effective management of painful diabetic neuropathy [ 11 ].…”

Peripheral Nerve Blocks in Patients with Diabetic Neuropathy and other Neuropathies: A Narrative Review.

“…Both pain management and surgical analgesia is a challenge in patients with diabetes mellitus. 1,2 The present management options for diabetic polyneuropathy include stringent glycemic control and pain management by pharmacotherapy such as opioids, anticonvulsants, tricyclic antidepressants, selective serotonin, and noradrenaline reuptake inhibitors, anesthetic patches, etc. However, the management of pain in diabetic neuropathy still remains a challenge to clinicians as the current strategies are not satisfactory.…”

“…However, the management of pain in diabetic neuropathy still remains a challenge to clinicians as the current strategies are not satisfactory. 1,2 An effective tool for analgesia in both Type 1 and Type 2 diabetic patients for perioperative management and pain control is peripheral nerve blocks. In the case of surgery, peripheral nerve block provides better and prolonged anesthesia than general anesthesia and also avoids the insulin-resistance and cardiopulmonary effects of general anesthesia.…”