title: Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: a double-blind randomized controlled study.
abstract: Pain relief in complex regional pain syndrome (CRPS) remains a major challenge, in part due to the lack of evidence-based treatment trials specific for this condition. We performed a long-term randomized, double-blinded active-control study to evaluate the efficacy of thoracic sympathetic block (TSB) for upper limb type I CRPS. The study objective was to evaluate the analgesic effect of TSB in CRPS. Patients with CRPS type I were treated with standardized pharmacological and physical therapy and were randomized to either TSB or control procedure as an add-on treatment. Clinical data, pain intensity, and interference (Brief Pain Inventory), pain dimensions (McGill Pain Questionnaire [MPQ]), neuropathic characteristics (Neuropathic Pain Symptom Inventory [NPSI]), mood, upper limb function (Disabilities of Arm, Shoulder and Hand), and quality of life were assessed before, and at 1 month and 12 months after the procedure. Thirty-six patients (19 female, 44.7 ± 11.1 years of age) underwent the procedure (17 in the TSB group). Average pain intensity at 1 month was not significantly different after TSB (3.5 ± 3.2) compared to control procedure (4.8 ± 2.7; P=0.249). At 12 months, however, the average pain item was significantly lower in the TSB group (3.47 ± 3.5) compared to the control group (5.86 ± 2.9; P=0.046). Scores from the MPQ, evoked-pain symptoms subscores (NPSI), and depression scores (Hospital Anxiety and Depression Scale) were significantly lower in the TSB group compared to the control group at 1 and at 12 months. Other measurements were not influenced by the treatment. Quality of life was only slightly improved by TSB. No major adverse events occurred. Larger, multicentric trials should be performed to confirm these original findings.
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil. Electronic address: contato@drrobertorocha.com.br.
authors.forename: Roberto de Oliveira
authors.initials: Rde O
authors.lastname: Rocha
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Neurosurgery Division, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Medicine, Department of Orthopedics, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Lin Tchia
authors.initials: LT
authors.lastname: Yeng
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Medicine, Department of Orthopedics, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Mirlene Gardin
authors.initials: MG
authors.lastname: Cantara
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Medicine, Department of Orthopedics, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Viviane Gentil
authors.initials: VG
authors.lastname: Faria
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Physical Medicine, Department of Orthopedics, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Victor
authors.initials: V
authors.lastname: Liggieri
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Adrianna
authors.initials: A
authors.lastname: Loduca
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Barbara Maria
authors.initials: BM
authors.lastname: Müller
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Andrea C M S
authors.initials: AC
authors.lastname: Souza
authors.affiliation: Pain Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, University of São Paulo, São Paulo, Brazil.
authors.forename: Daniel Ciampi
authors.initials: DC
authors.lastname: de Andrade
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D003863:Depression / Q000209:etiology; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D012019:Reflex Sympathetic Dystrophy / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000534:rehabilitation*; D013565:Sympatholytics / Q000627:therapeutic use*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology
chemical_list: D000779:Anesthetics, Local; D013565:Sympatholytics; D008012:Lidocaine
keywords: Complex regional pain syndrome; Sympathetic nerve block; Thoracic column; Upper limbs