Lumbar Sympathetic Blocks:

can be done for the following kinds of LEG PAIN if not responding to medicines:

• burning pain ( complex regional pain syndrome)

• shingles of the legs ( herpes zoster infection)

• blood vessels problems or blockage causing pain

• small nerves or nerve endings causing pain ( eg diabetic nerve disease)

• phantom limb ( feeling that an amputated limb is still attached)

Procedure:

You will lie on your stomach on an x-ray table. The doctor will numb an area of skin on your lower back with a local anesthetic. Then, guided by an x-ray, he or she will:

• Insert a needle into your back, along the outside of your spine

• Inject dye to confirm that medication will go to the correct spot

• Inject a local anesthetic first, followed by a steroid medication

Pain relief can occur immediately after the injection, but the pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work.

Repeated injections for treatment :

• are only typically needed if there has been >50% pain relief, increase in function/ activity or reduction in use of medicines or exercise services, for 2 months.

These injections should not be performed for/ when :

higher risk of bleeding due to being on certain medicines ( blood thinners), certain medical conditions etc; fracture; infection; uncontrolled diabetes and glaucoma; mostly functional ( psychogenic) pain; allergic reactions to substances used in injections; low blood volume; pregnancy. They can cause nerve damage, paralysis, hematuria (blood in the urine), numbness, weakness, and medication side effects. They should be cautiously used or not at all in multiple sclerosis, or any other neurological condition where worsening disease features are masked by these injections

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