What is the efficacy of sympathetic interventions in the treatment of complex regional pain syndrome (CRPS)?

Updated: Jun 20, 2018
  • Author: Gaurav Gupta, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Many uncontrolled surveys in the literature examine the effect of sympathetic interventions on CRPS, and approximately 70% of patients report full or partial responses. [102] However, the efficacy of these procedures is still a subject of controversy. [76, 103] In fact, their specificity and long-term results, as well as the techniques themselves, have not been adequately evaluated.

One controlled study in patients with CRPS type I found that sympathetic ganglion blocks using local anesthetic had the same immediate effect on pain as a control injection with saline. [104] However, after 24 hours, patients in the local anesthetic group remained markedly improved relative to the control group, indicating the delayed efficacy of this particular intervention. With this data in mind, the aforementioned uncontrolled studies must be interpreted cautiously.

Most data regarding efficacy must be scrutinized for failing to look at the long-term outcomes of these interventions. A meta‑analysis of studies assessing the effect of local anesthetic sympathetic blockade for the treatment of CRPS showed that the literature was inadequate to draw any conclusions regarding the effectiveness of this procedure, mainly due to small sample sizes and a lack of long-term follow-up. [105]


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