Ultrasound-guided pulsed radiofrequency treatment of the cervical sympathetic chain for complex regional pain syndrome

Abstract

The stellate ganglion is a common target to manage neuropathic pain in the upper extremities. However, the effect duration of a single stellate ganglion block is often temporary. To overcome the short-term effects of a single sympathetic block, pulsed radiofrequency (PRF) can be applied. The aim of the present study was to investigate the efficacy of PRF on the cervical sympathetic chain under ultrasound guidance for complex regional pain syndrome (CRPS).Twelve CRPS patients who underwent PRF on the cervical sympathetic chain were enrolled in this retrospective analysis. Under ultrasound guidance, PRF was performed for 420 seconds at 42°C on the C6- and C7-level sympathetic chain.The pain intensity decreased significantly at 1 week after the procedure. Overall, 91.7% of patients experienced at least moderate improvement. A positive correlation was observed between the extent of pain reduction at 1 week after PRF and the degree of overall benefit (r = 0.605, P = 0.037). This reduction in symptoms was maintained for a mean of 31.41 ± 26.07 days after PRF. There were no complications associated with this procedure.PRF on the cervical sympathetic chain, which can be performed easily and safely under ultrasound guidance, should be considered an option for managing CRPS of the upper extremities.

Clinical effects of pulsed radiofrequency to the thoracic sympathetic ganglion versus the cervical sympathetic chain in patients with upper-extremity complex regional pain syndrome

“…[6] Additionally, the effect range of the EM field is much smaller than that of a few milliliters of local anesthetic. [9] Therefore, when performing PRF, it is ideal to position the needle tip as close as possible to the target nerve.…”

“…[6] Although PRF is increasingly used to treat various pain conditions, [7] its application to sympathetic nerve has been rarely reported. [8,9] We previously reported our clinical experience using PRF on the cervical sympathetic chain (CSC PRF). [9] However, there are no published reports on the application of PRF to the TSG (TSG PRF).…”

“…[8,9] We previously reported our clinical experience using PRF on the cervical sympathetic chain (CSC PRF). [9] However, there are no published reports on the application of PRF to the TSG (TSG PRF).…”

Poststroke Pain

“…50 This has been supported by several previous studies reporting that local anesthetic blockade of the sympathetic chain effectively controlled CRPS symptoms. [51][52][53] Furthermore, persistent noxious input resulting from nerve damage increases the excitability of nociceptive neurons in the spinal cord, referred to as central sensitization. 54 Central sensitization results in hyperesthesia, allodynia, and hyperalgesia.…”

“…Additionally, several previous studies have found that repeated sympathetic blockade with local anesthetics can attenuate CRPS symptoms. [51][52][53] In refractory cases of CRPS, spinal cord stimulation was found to have potential to relieve such symptoms. 64 In addition to the aforementioned medications and procedures, combined treatment with active or passive mobilization, massage, contrast baths, and transcutaneous electrical nerve stimulation have been used as adjunctive therapies to help manage CRPS, although data regarding efficacy are limited.…”