Chemical sympathectomy for neuropathic pain: does it work? Case report and systematic literature review.
OBJECTIVE
To determine if chemical sympathectomy successfully reduces limb neuropathic pain.


METHODS
Systematic literature review of the effectiveness of phenol or alcohol sympathectomy for extremity neuropathic pain.


METHODS
A 29-year-old female with complex regional pain syndrome of both lower extremities after back surgery who was submitted to bilateral lumbar chemical sympathectomy.


METHODS
The Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, Medline, and EMBASE were systematically searched.


METHODS
(1) For the patient in question: spontaneous pain, allodynia, pinprick hyperalgesia, pressure evoked pain; (2) For the literature review: meaningful versus nonmeaningful pain relief based on degree and duration (>2 weeks) of pain relief.


RESULTS
(1) The case reported experienced partial temporary relief of pain primarily related to selective modulation of allodynia, but not deep pain or pinprick hyperalgesia; (2) 44% of 66 patients in 13 studies that met the authors' inclusion criteria experienced meaningful pain relief. Whereas 19% experienced no meaningful relief, for the remaining 37% of the patients no conclusions regarding duration and degree of relief could be drawn due to poor reporting of outcomes.


CONCLUSIONS
Based on the case reported and systematic literature review, chemical sympathectomy seems to have at best a temporary effect, limited to cutaneous allodynia. Despite the popularity of chemical sympatholysis, only few patients and poorly defined outcomes are reported in the literature, substantiating the need for well-designed studies on the effectiveness of the procedure.
Furlan
A D
AD
Comprehensive Pain Program, The Toronto Western Hospital, and Institute for Work & Health, Ontario, Canada.
Lui
P W
PW
Mailis
A
A
D000328:Adult; D020918:Complex Regional Pain Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D017116:Low Back Pain / Q000601:surgery*; D019800:Phenol / Q000627:therapeutic use; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects*; D013563:Sympathectomy, Chemical / Q000592:standards*
D019800:Phenol; D000431:Ethanol