About Sympathetic Nerve Blocks
The sympathetic nervous system runs alongside the spine and controls automatic functions such as blood flow and sweating. In some chronic pain conditions, especially complex regional pain syndrome, these nerves seem to amplify pain. A block temporarily quiets them.
For arm or face pain, the target is usually the stellate ganglion in the front of the neck, which Dr. Chen reaches with ultrasound guidance. For leg pain, the target is the lumbar sympathetic chain beside the lower spine, which is usually reached with X-ray guidance.
Blocks are often done as a series. Their main value is to lower pain enough that you can take part in the desensitization and graded movement work that are central to CRPS recovery. They can also help confirm the diagnosis.
What happens during treatment
- 1.
Dr. Chen reviews your symptoms, examines the affected limb, and discusses the goals of the block.
- 2.
You lie in position, and your blood pressure, heart rate, and limb temperature are monitored.
- 3.
Using imaging guidance, a thin needle is placed near the sympathetic nerves and local anesthetic is injected.
- 4.
Over the next several minutes the treated limb often feels warmer. You rest briefly before going home with a driver.
Who may be a good candidate
- People with complex regional pain syndrome of an arm or leg.
- People with certain other chronic pain conditions linked to sympathetic nerve activity, such as some cases of vascular or nerve pain.
- People who need pain relief to take part in physical or occupational therapy.
Recovery
Most people return to normal activity the next day. After a neck block, a droopy eyelid, a small pupil, a hoarse voice, or a feeling of a lump in the throat are common for a few hours; eat and drink carefully until these fade. After a lumbar block, the leg may feel warm or slightly numb for a few hours. Scheduling therapy soon after a block helps you make the most of the relief.
Risks and limits
Common temporary effects include soreness, lightheadedness, and the neck block effects described above. Rare but serious risks include injection into a blood vessel, which can cause a seizure, bleeding, infection, nerve injury, and, with the neck block, a collapsed lung. You may need to pause blood thinners with your prescribing doctor's approval. Blocks do not help everyone, and relief may be short-lived.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about Sympathetic Blocks
- How many sympathetic nerve blocks will I need?
- It varies. Blocks are often done as a short series if the first one helps. The number depends on how long relief lasts and how well you progress with therapy between blocks.
- Why does my arm or leg feel warm after the block?
- Warmth is a sign the block reached the sympathetic nerves, which widen blood vessels when they are quieted. It usually fades within hours.
- Can I drive home after a sympathetic nerve block?
- No. Please bring a driver, since numbness, lightheadedness, or temporary eyelid drooping can make driving unsafe. Most people feel back to normal by the next day.