Sympathetic chain blocks
Sympathetic chain blocks are image-guided procedures that help diagnose and treat certain types of chronic pain. The procedures target nerves that may be contributing to this ongoing pain.
The sympathetic nervous system helps regulate many of our involuntary bodily functions. These include blood flow, sweating, temperature regulation and certain pain responses.
With some chronic pain conditions, abnormal sympathetic nervous system activity may contribute to ongoing pain, hypersensitivity and autonomic dysfunction.
At the University of Kentucky Interventional Pain Medicine program, we use sympathetic nerve blocks as part of a comprehensive approach to treat complex pain conditions.
Conditions commonly treated
Sympathetic chain blocks may be an option for patients with:
- Complex regional pain syndrome (CRPS)
- Neuropathic pain
- Cancer-related pain
- Nerve pain after surgery
- Sympathetically maintained pain conditions
We will create your treatment plan based on your symptoms, diagnosis, imaging findings and past treatments.
How sympathetic blocks work
These procedures involve placing local anesthetic, with or without corticosteroid medicine, near targeted sympathetic nerve structures to temporarily interrupt abnormal pain signaling.
The goals of treatment may include:
- Reducing pain
- Improving blood flow
- Improving function and mobility
- Reducing autonomic symptoms
- Assisting with diagnosis of sympathetically mediated pain
We typically use fluoroscopic (X-ray) or ultrasound guidance to perform these procedures to improve precision and safety.
Common sympathetic block procedures
The stellate ganglion is a collection of sympathetic nerves in the cervical spine region.
We may consider stellate ganglion blocks for:
- Upper extremity complex regional pain syndrome (CRPS)
- Neuropathic arm pain
- Sympathetically maintained pain conditions affecting the head, neck or upper extremities.
Lumbar sympathetic blocks target sympathetic nerves in the lumbar spine region.
These procedures may be an option for:
- Lower extremity complex regional pain syndrome (CRPS)
- Neuropathic leg pain
- Sympathetically maintained lower extremity pain
The celiac plexus is a network of nerves near the upper abdominal aorta.
We may consider celiac plexus blocks for pancreatic cancer pain.
Superior hypogastric plexus blocks target nerves that carry pain signals from the pelvic area.
These procedures may be an option for:
- Cancer-related pelvic pain
- Visceral pelvic pain syndromes
The ganglion impar is a nerve cluster near the tailbone that can send pain signals from the pelvic and perineal region.
Ganglion impar blocks may be considered for:
- Coccyx pain
- Perineal pain syndromes
The sphenopalatine ganglion is a nerve structure associated with certain headache and facial pain conditions.
These blocks may be an option for:
- Certain headache disorders
- Neuropathic facial pain
What to expect
During the procedure, we:
- Clean the skin using sterile technique
- Use local anesthetic to numb the skin
- Use image guidance to identify the target anatomy
- Deliver medicine near the targeted sympathetic nerves
These procedures are usually outpatient, with patients going home the same day.
Some patients may experience temporary numbness, warmth or changes in sensation after the procedure, depending on the nerves treated.
Risks
Risks are generally low but may include:
- Bleeding
- Infection
- Temporary weakness or numbness
- Allergic reaction
- Nerve irritation
- Temporary blood pressure changes
- Incomplete pain relief
Your physician will review the risks and benefits of the procedure during your evaluation.
Multidisciplinary pain care
The UK Interventional Pain Medicine program provides comprehensive evaluation and treatment for complex pain conditions. We use a multidisciplinary approach that may include:
- Physical therapy
- Rehabilitation strategies
- Medication management
- Psychological support services
- Neuromodulation
- Image-guided interventional procedures
- Cancer pain collaboration
We personalize treatment plans based on your symptoms, imaging findings, pain treatments and functional goals.