Sympathetic Nerve Block Treatment in NYC

A sympathetic nerve block involves injecting numbing medication with or without steroid around a specific group of nerves involved in the body’s sympathetic nervous system. These nerves have been linked to pain when they are damaged or are misfiring. The sympathetic nerves are a chain of nerves that spread out from your spine. They prep your body for fight or flight at times of stress and help control your body’s involuntary functions—or body functions that you can’t control—such as pain, digestion, blood flow, and sweating.

A lumbar sympathetic block works to “block” the sympathetic nerves that run to your leg on the same side as that of the injection. This, in turn, helps reduce pain, swelling, and sweating as well as improves mobility.

A sympathetic block helps switch off pain signals by injecting an anesthetic (numbing) medication into the sympathetic nerves near your spine. If these nerves are the source of your pain, the sympathetic block may offer relief for some time after the procedure. If effective, your doctor may recommend a series of these blocks 1-2 weeks apart, which may give you more long-term pain relief.

All insurance providers cover sympathetic nerve blocks provided that the initial diagnostic sympathetic block is medically necessary to establish the source of pain. Additional nerve blocks are covered when the initial procedure has been capable of: reducing your pain levels by at least 50%, noticeably reducing the use of your pain medication, and improving the function and strength of the affected part.

After a sympathetic nerve block, your pain in the affected area may go away. You may stay pain-free longer than the duration required for the numbing medication to wear off, indicating that the block was effective. However, if this is not the case, your pain levels will not improve, showing that the sympathetic nerves were not the source of pain. And your doctor will then proceed with other tests to pinpoint the origin of the pain. If the block works, your doctor will most likely recommend a series of similar blocks every 1-2 weeks to achieve a more lasting benefit.

Moreover, when the numbing medication wears off, you may notice some increase in your pain levels, lasting for several days. Mild pain at the injection site is common. It will typically get better with icing during the first two to three days after the procedure.

If you received a sympathetic nerve block in your back (lumbar), there might also be increased warmth in your leg, lasting for several hours after the block.
If a nerve block was done in your neck area (stellate ganglion), you may notice a droopy eyelid, redness in the eye, or redness of the face. These effects, however, are normal and will subside within a few hours.

It is not always possible to predict how long will a sympathetic nerve block lasts. If the block works, you may notice pain relief right away. However, your pain will return as soon as the numbing medicine wears off unless you have received a steroid shot (that takes time to kick in). Typically, the duration of pain gets longer after each successive injection. Thus, you will need a series of several sympathetic blocks to achieve long-lasting results.

For a lumbar sympathetic block, you will lie face down on an x-ray table. You may receive a low-dose sedative to relax you. The skin on your back is cleaned with an antiseptic solution and numbed with a local anesthetic. Using X-ray guidance, a needle or needles is (are) then advanced into your back along the outside of your spine. Your doctor will then inject dye to ensure that the steroid medication will go to the correct spot. The drug is then injected slowly over several minutes under X-ray guidance. The needle is finally removed, and the treated area is covered with a Band-Aid.

The stellate ganglion is where the sympathetic nerves for your arms come from. When the injection is done to block the sympathetic nerves from firing, it is called a block.

A stellate ganglion block can be performed by pain management specialists.

A stellate ganglion is a cluster of nerves located at the front of your neck. A stellate ganglion block is an injection of numbing medicine to block the sympathetic nerves that run on either side of the voice box in your neck. Some of the common conditions treated by stellate ganglion block include complex regional pain syndrome, pain of the head and neck, and post-traumatic stress disorder (PTSD).

First, you will receive a relaxing medication. You’ll lie on your back on an x-ray table, and the front of your neck will be cleansed and numbed. Your doctor will use an x-ray or ultrasound guidance to guide the injection needle into your throat, close to your voice box. Contrast dye is injected to confirm the needle’s location before injecting the steroid (anti-inflammatory medication). The medication is then carefully injected, and the needle is finally taken out.

If your symptoms get better after the first shot, you will be suggested to get repeat injections. Usually, a series of such blocks is required to treat the problem. Some people report significant relief only after two to four sessions, while others may require more than four different sessions of injections. Ideally, the total number of blocks should not exceed six times.

Predicting how long will a stellate ganglion block lasts varies from person to person. At times, blockade of the stellate ganglion can offer long-term relief. For most patients, however, a stellate ganglion block provides temporary relief. In general, the pain relief phase lasts longer with each repeated injection. At the end of the series of injections, most patients report 50% to 80% of pain relief that lasts for 6-12 months.

A stellate ganglion is part of the sympathetic nervous system that supplies your face, neck, and arm. Hence, a blockade of this ganglion works to block pain signals in these parts of your body.

People with PTSD or people who have experienced an extremely traumatic situation have an increased “fight or flight response” (or an over-activated sympathetic nervous system). This response increases the levels of an adrenaline-like chemical, which, in turn, over activates the fear center of their brain called the amygdala.
The stellate ganglion is a part of the sympathetic nervous system that also oversees the activation of the amygdala. Though it is not precisely known how a stellate ganglion block works, it seems to calm down the exaggerated “flight or fight” response in people with PTSD. This helps to reset the amygdala. Thus, blocking the stellate ganglion helps alleviate the symptoms of PTSD immediately and offers long-lasting benefits.

Because a stellate ganglion block involves inserting a needle, the procedure does cause some soreness at the injection site. However, numbing your skin and deeper body tissues with a numbing agent using a very thin needle before advancing the actual block needle helps minimize pain.