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Chronic pain is one of the most common medical problems encountered by physicians. It has been described as an unpleasant sensation that persists for at least 4 months, and often continues for an indefinite period of time. In the United States alone, more than 90 million people suffer from a variety of chronic pain syndromes. Chronic pain often disrupts family life, reduces function, and is a financial strain. Chronic pain is more common and causes more disability than cancer and heart disease combined. The drain on the U.S. economy produced by chronic pain is enormous, amounting to more than 100 billion dollars a year in medical expenses, lost work productivity, and insurance costs.

Use of interventional pain management procedures in the treatment of chronic benign and malignant pain can offer significant pain relief, improving function and reducing medical costs for patients, and provides a better quality of life and death for those with terminal disease. This chapter reviews indications, contraindications, complications, efficacy, and techniques for the most common interventional procedures used in the treatment of chronic pain.


General Considerations

The sympathetic nervous system works in conjunction with the parasympathetic nervous system to provide homeostasis for many bodily functions. Sympathetic nerves provide innervation to a variety of structures, including the skin, blood vessels, and internal organs. The sympathetic nervous system can lead to ongoing chronic neuropathic pain involving the extremities, face, abdomen, and pelvis. Sympathetic nerve blocks are often used to treat a spectrum of neuropathic disorders from sympathetically maintained pain to complex regional pain syndromes. The pain can be mild and self-limited, as in a sunburn, or severe and chronic, as in trigeminal neuralgia, complex regional pain syndrome, and diabetic peripheral neuropathy. Sympathetic nerve blocks are used diagnostically to identify a neuropathic disorder (eg, complex regional pain syndrome) and therapeutically in the treatment of neuropathic conditions that have not responded to more conservative care.

1. Cervical Sympathetic Injection


Cervical sympathetic injections are performed to treat neuropathic facial pain, such as trigeminal neuralgia, headaches (cluster, migraine), and atypical facial pain. These nerve blocks can also be used in the treatment of facial pain related to different types of cancer involving the head and neck. They are also used for neuropathic upper extremity pain, as seen with sympathetically maintained pain, radiculopathy, and complex regional pain syndromes. An increased temperature recorded in the involved extremity reflects a successful injection resulting from blockade of the sympathetic nerves. In regard to facial pain, the observation of a Horner’s syndrome postinjection, consisting of ptosis, enophthalmos, miosis, and anhidrosis, confirms an effective blockade.


The cervical sympathetic ganglion, also known as the stellate ganglion, is located anterolateral to the C7 vertebral body and consists of a union between ...

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