Lumbar Sympathetic Block

If you find yourself experiencing chronic leg pain and foot pain, you may be suffering from an underlying health condition requiring more extensive treatment than what an over-the-counter medication can provide. Any type of chronic pain should be monitored by a medical professional or a trained specialist like a physician skilled in pain management. Your medical professional may recommend a Lumbar Sympathetic Block to treat and manage your pain symptoms.  

The sympathetic nerves that exist on either side of the spine in the lower back control basic functioning in the body. They carry messages from tissue to the spinal cord and brain. These nerves also control functions like regulating blood flow.  

A lumbar sympathetic block is a lumbar nerve “block” that stops pain signals from being sent to the legs and feet. The sympathetic block is performed on the side of the body where the pain exists. The injection is composed of medication that contains steroid and a local anesthetic, effective in reducing pain in the sympathetic nerves. The lumbar sympathetic block delivers medication to the sympathetic ganglia by the spine, reducing inflammation and blocking pain signals. 

Do Lumbar Sympathetic Blocks Work?

When the lumbar block is delivered to the branch of nerves suspected of causing pain, it can produce diagnostic results and/or therapeutic results. This minimally invasive procedure can provide pain relief from the anesthetic and long term relief from the steroid. If the nerves suspected of causing symptoms experience relief, then it is likely the source of the pain. Your doctor may recommend a series of the injections for long term relief.  

The procedure is performed in a sterile environment. You will be positioned according to the location of your pain. The injection site will be cleansed using betadine or alcohol. Your physician will anesthetize your skin using local anesthetic. A small needle with medication will deliver the anesthetic to the site of pain. You may experience pressure at the site. The process may take up to 15 minutes to administer. You may begin to notice immediate relief, but it may take a day or two for the medication to take full effect.  

The nerves, muscles, and tissue surround the affected area of the sacroiliac joint are bathed in the solution from the injection, reducing inflammation and pain. This allows patients to experience better mobility and help them return to a fully functioning life. Some patients may even benefit from the short term relief because it allows them to participate in physical therapy (another treatment method for lumbar nerve pain) for long term relief.

What Are Sympathetic Nerves?

The sympathetic nervous system (SNS) is actually part of the autonomic nervous system (ANS). The autonomic nervous system is comprised of both the sympathetic and parasympathetic nervous systems and works to regulate different functions in the body.  

The sympathetic nerves run parallel to the spinal cord, located on both sides of the vertebral column. The sympathetic nerves respond to stress and increases in the stress hormone known as cortisol and triggers the fight-or-flight response in the body. They also aid in certain involuntary bodily functions such as digestion, sweating, and blood flow. The sympathetic nerves start near the middle of the spinal cord and extend down into the second or third lumbar vertebrae. 

Lumbar Nerve Block Overview

A lumbar sympathetic block is applied as an injection of steroid medication to the affected area. The lumbar block disrupts the nerve supply from the sympathetic nervous system in order to block pain signals from reaching the lower extremities. It also helps with issues such as swelling or sweating and generally will improve mobility. 

A pain management doctor may use this type of injection in order to treat cases of shingles, phantom limb pain, vascular inefficiencies, peripheral neuropathy, diabetic neuropathy, complex regional pain syndrome (CRPS), frostbite, cancer pain, reflex sympathetic dystrophy, excessive sweating, and Raynaud’s syndrome. Your doctor might turn to this procedure if you have tried others that have not previously worked.  

According to the National Institute for Health and Clinical Excellence, about 20% of patients with painful ischemia of the lower limbs are not candidates for surgical interventions because of their disease or a co-morbid condition. These patients may benefit from lumbar sympathetic blocks and can potentially see an improvement in the healing of wounds and might delay possible amputations. This is just one example of how this procedure can provide real and significant relief for those who may not have other options or have tried other treatments that have failed. 

How A Lumbar Sympathetic Nerve Block Is Given

Before the procedure, the doctor will take the patient’s medical history and answer any questions they might have. The patient will most likely need to stop taking any blood thinners they are taking, under the supervision of their medical provider, and possibly other medications. The patient should be sure to let their pain management doctor know if they have recently had any health problems (ex. infections) and inform them of all medications taken (including over-the-counter or vitamins), any allergies, if there have been any past reactions to anesthesia/other medicines, and if there is the chance the patient is pregnant.   

Since this is an outpatient treatment, where the patient will be able to go home after having the lumbar block, the patient should arrange to have someone drive them to and from the office, as they will not be able to drive afterward. The doctor will also specify a specific time for the patient to stop eating or drinking before the procedure. 

Lumbar sympathetic blocks are given under local anesthetic and the patient may receive a type of medication through an intravenous line (IV) to help them relax during the procedure. Before the injection is given, the patient will lie down on their stomach and the area where they will receive the injection will be cleaned and the local anesthetic will be administered. Patients will be awake while having the injection, but should not feel much if anything at all.  

Once the anesthesia has taken affect, the doctor will insert a hollow needle and inject a contrast dye in order to confirm the correct spot to administer the medication. This and the actual injection of the medication will be done under fluoroscopy (X-rays) so the doctor can see to guide the needle to the lumbar sympathetic ganglia that is being treated. The doctor will most likely be administering a steroid medication to numb the spot and reduce inflammation, which effectively stops the pain, and this could be a type of corticosteroid, including dexamethasone, triamcinolone, or betamethasone. The needle is then removed and the patient may be watched for a short time for any immediate reactions. 

What Happens After The Sympathetic Nerve Block? 

While patients will not be able to drive, they should be fully back to performing daily activities the next day. Patients will be advised not to swim or soak in a tub for the next 72 hours. Any soreness that occurs can usually be relieved using an ice pack or taking an over-the-counter pain reliever (be sure to consult with your doctor first). If numbness hasn’t gone away after 24 hours or there is a loss of bladder or bowel control then the patient needs to seek immediate medical attention.  

Patients may not feel the effects of the lumbar block until a few days later and how long they find relief from their pain varies, depending on the person. Some may see relief for weeks and some may see relief for months. A couple of more injections may be needed throughout the year, but should be limited due to potential risks. Patients may also benefit from physical therapy in conjunction with the sympathetic nerve block to get the maximum pain relief.  

What Are The Risks of Lumbar Blocks

Overall risks for lumbar sympathetic nerve blocks are relatively low, but not completely zero. This is a minor treatment that is non-invasive, so the chances of having a serious complication are not very likely. However, the patient should keep an eye out for signs of infection or bleeding. Infections are one of the more concerning outcomes of this procedure, but can be treated easily with an antibiotic. There are also chances of an allergic reaction to the medication or nerve damage occurring. Generally, the patient can expect some potential bruising or soreness at the injection site for a few days. 

What Do Lumbar Sympathetic Blocks Treat?

A lumbar ganglion block is successful in treating several symptoms of various conditions. Once your medical professional has determined your pain symptoms are a result of specific sympathetic nerves in the lumbar region of the back, effective treatment can begin. This sympathetic block can treat: 

• Shingles pain in the legs 
• Phantom limb pain 
• Diabetic neuropathy in the legs (not relieved from medication) 
• CRPS (complex regional pain syndrome) 
• Vascular insufficiency from vessel blockage in the legs 

Immediately after the injection, a patient may also experience a temporary increase in pain before the anesthetic is experienced. Sometimes, diabetics may experience a temporarily elevated blood sugar. You will need to take precautions to not overexert yourself and injure the injection site. You will also be asked not to sit in any pools or tubs for 48 hours after the injection to prevent infection. The steroid medication may take 2-3 days to start having a full effect. Patients can use an ice pack applied to the area to alleviate any discomfort.