title: Bilateral pain relief after unilateral thoracic percutaneous sympathectomy.
abstract: OBJECTIVE
  To present a case of unexpected bilateral pain relief following unilateral thoracic percutaneous sympathectomy.
  
  
  RESULTS
  We present a case report where severe ischemic pain due to paraneoplastic Raynaud's syndrome with distal gangrene was successfully treated by means of percutaneous thoracic sympathectomy. A unilateral T2, T3 radiofrequency sympathectomy combined with small volume phenol injection resulted in unexpected bilateral pain relief.
  
  
  CONCLUSIONS
  Our observations from this case report suggest a possible crossover of sympathetic innervation at the cervical and thoracic levels. Percutanenous thoracic radiofrequency sympathectomy is a feasible option for the treatment of refractory ischemic upper limb pain.
authors.affiliation: Department of Anesthesia, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Ontario M4N 3M5, Canada. mgofeld@rogers.com
authors.forename: Michael
authors.initials: M
authors.lastname: Gofeld
authors.forename: Gil
authors.initials: G
authors.lastname: Faclier
mesh_terms: D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods; D005385:Fingers / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology; D005734:Gangrene / Q000150:complications; D006801:Humans; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D010257:Paraneoplastic Syndromes / Q000150:complications; D019800:Phenol / Q000627:therapeutic use; D011928:Raynaud Disease / Q000150:complications / Q000601:surgery*; D012597:Sclerosing Solutions / Q000627:therapeutic use; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D013900:Thoracic Nerves / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D019800:Phenol