The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population

Abstract

Objective The sympathetic nervous system has a recognized role in transmission of pain, and the lumbar sympathetic blockade is intended to provide analgesia. We share our experiences of lumbar sympathetic blockade in the treatment of cancer-related pain. Methods We performed a retrospective analysis of patients with cancer-related pain in the back, abdomen, pelvis, or legs treated at Memorial Sloan Kettering Cancer Center between 2000 and 2018 undergoing lumbar sympathetic blockade at L2 or L3. Blocks were accomplished by injection of local anesthetic or local anesthetic with steroid under fluoroscopy. We measured numerical rating scale scores, percent relief, and relief time. The primary end point was defined as “effective” or “ineffective” pain relief. Effective pain relief was defined as ≥30% relief for at least one day. Results We identified 124 data points of lumbar sympathetic blockade at L2 or L3, of which 57 were with complete data and used for analysis. Peri-injection, 42 data points had active disease whereas 15 were in remission. Lumbar sympathetic blockade was 67% effective in the back pain cohort, 82% effective in the abdominopelvic pain cohort, and 75% effective in the leg pain cohort. Seventeen data points went on to neurolysis, two to neuromodulation, and eight to intrathecal pump implantation. Conclusions Lumbar sympathetic blockade is effective for back, abdominopelvic, and leg pain related to cancer and its treatments. Future research should be aimed at refining its role within multimodal pain management.

Lumbar Sympathetic Block for Intractable Lower‐Limb Postherpetic Neuralgia: Report of Two Cases

“…Inadvertent vascular injection during a LSB may lead to systemic toxicity, seizure, spinal ischemia, or stroke, but even in child population with complex regional pain syndrome, it was found to be safe and effective. 1,14,15 Reactivation of dormant varicellazoster virus (VZV) occurs in the dorsal root ganglion (DRG), which results in both peripheral and central viral particle spread and neuronal damage. 16 Given the fact that there are sympathetic fibers within the DRG, delivering steroids to the sympathetic chain may be Sympathetic Block for Lower-Limb Postherpetic Neuralgia 355 thought to facilitate this spread and neuronal damage through immune suppression, but epidural or systemic steroid usage is not rare in acute shingles.…”

“…Sympathetic nervous system involvement to the neuropathic, visceral, or vascular pain creates a rational basis to the treatment. [1][2][3][4] Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by allodynia, hyperalgesia, and persistent pain that occurs after the acute onset of herpes zoster. The pain often affects individuals' quality of life and sleep, activities of daily living, and psychological status severely.…”

Efficacy of the lumbar sympathetic ganglion block in lower limb pain and its application prospects during the perioperative period

“…Studies have reported that patients with cancer‐related pain in the back, abdomen, pelvis, or legs can have their pain reduced by LSGB. LSGB provides good analgesia after surgery 63 . With regard to perioperative pain management, LSGB can reduce residual limb pain and PLP during the perioperative period and help patients to recover psychologically after surgery 43 .…”

“…LSGB provides good analgesia after surgery. 63 With regard to perioperative pain management, LSGB can reduce residual limb pain and PLP during the perioperative period and help patients to recover psychologically after surgery. 43 The causes of pain after lumbar spine surgery are complex.…”

Sympathectomy Ameliorates CFA-Induced Mechanical Allodynia via Modulating Phenotype of Macrophages in Sensory Ganglion in Mice

“…The sympathetic nervous system (SNS) is part of the autonomic nervous system, playing an important role in maintaining many painful conditions. 7 For example, chemical or surgical sympathectomy can effectively reduce neuropathic pain, 8 , 9 postoperative pain, 10 visceral pain, 11 cancer-related pain, 12 limb ischemic pain, complex regional pain syndrome (CRPS), pain related to postherpetic neuralgia 13 , 14 and peripheral inflammation. 15 Previous studies suggested that the SNS might involve in the pathophysiology of pain via regulating the nociceptors and the immune cells in the peripheral.…”