A surgical sympathectomy is a procedure in which certain nerves are destroyed in order to stop pain sensations. Sympathectomy surgeries are sometimes used in CRPS cases in which other forms of treatment have not been successful. The use of surgical sympathectomy in general, and as a CRPS treatment method in particular, is highly controversial.
Sympathectomy Surgery Consideration
Sympathectomy surgery is most effective in treatment of CRPS if it is done shortly after the CRPS diagnosis. However, other less invasive treatment methods should be discussed and administered prior to deciding upon sympathectomy surgery. CRPS patients that have responded well to sympathetic nerve blocks, administered through injections, usually make the best candidates for sympathectomy surgery.
CRPS Sympathectomy Surgery
Prior to sympathectomy surgery, patients may be asked to lose weight or change eating or behavioral habits in order to decrease the risk of complications. Most sympathectomy surgeries use a similar technique. The patient is put under anesthesia, and several incisions are made in the chest area. An endoscope is inserted into the body through one incision, and surgical tools are inserted through the others. The sympathetic nerves are carefully detached, and the incisions are closed.
Regional CRPS Pain
If only one arm or leg is affected by CRPS pain, a simpler procedure may be possible to detach sympathetic nerves. During this procedure, X-rays and electrical stimulation are used to pinpoint the exact location of the sympathetic nerves. The nerves are then detached using radio waves without making any incisions.
CRPS Sympathectomy Benefits
A sympathectomy can diminish or eliminate symptoms of CRPS that are caused by the sympathetic nervous system. In some CRPS cases pain, temperature changes, skin texture changes, and swelling may cease after a sympathectomy. When relieved of these symptoms, patients may recover from CRPS to varying degrees.
Effective CRPS Sympathectomy
If a sympathectomy is successful in treating CRPS, patients may begin to recover quality of life. Unhindered by CRPS pain, patients may begin to participate in hobbies and daily tasks, and possibly resume work activities. Patients’ mental state may improve with the decrease in limitations and relief of chronic pain.
CRPS Sympathectomy Disadvantages
In many cases, sympathectomy has not been effective as a long term solution to CRPS pain and symptoms. Over time, patients may begin to feel CRPS pain in other areas of the body. Sympathetic nerves are also known to regenerate, which would require subsequent surgeries or other treatment methods.
CRPS Sympathectomy Risks
There are certain risks inherent in sympathectomy surgeries. Since nerves are intentionally being detached or destroyed, it is possible to inadvertently disconnect or destroy nerves that are not connected to the source of the CRPS pain. This can inhibit certain motor or sensory functions.
Many patients that have undergone sympathectomy surgery for CRPS report post-sympathectomy pain close to the initial site of CRPS pain. The cause of this pain is not completely understood, but subsequent nerve blocks may be beneficial in stopping the pain. Since post-sympathectomy pain is somewhat common, physicians often screen for it during follow up appointments.
Other risks that may occur following CRPS sympathectomy surgery include:
- Decreased blood pressure
- Impaired fertility
- Sweat increase or decrease, especially in the hands
- Chest pain
- Air in the chest cavity
- Death in rare cases, usually due to serious decrease in blood pressure
CRPS Sympathectomy Controversy
Sympathectomy surgery as a solution to CRPS symptoms and pain is a topic of debate among physicians. Many physicians feel that the risks and the invasiveness of the surgery outweigh the possible benefits, especially due to the short-term nature of effectiveness for most patients. Since CRPS is a condition for which no cure has been found, however, many other physicians feel that any effective treatment may warrant the risks involved. Patients should be sure to research and discuss all possible options for CRPS prior to deciding upon sympathectomy surgery to treat CRPS.
“Clinical Practice Guidelines.” International Research Foundation for RSD/CRPS. International Research Foundation for RSD/CRPS, n.d. Web. 9 Mar 2014. <http://www.rsdfoundation.org/en/en_clinical_practice_guidelines.html
“Complex Regional Pain Syndrome Fact Sheet.” National Institute of Neurological Disorders and Stroke. U.S. Department of Health and Human Services, 12 Jul 2013. Web. 9 Mar 2014. <http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm
Hooshmand, H. “CRPS and Sympathectomy.”Neurological Associates Pain Management Center. Neurological Associates Pain Management Center, 29 Jun 2006. Web. 9 Mar 2014. <http://www.rsdrx.com/crps_and_sympathectomy.htm>.
Singh, B, and J Moodley. “Sympathectomy for Complex Regional Pain Syndrome.” PubMed. 37(3).March (2003): 508-511. Web. 9 Mar. 2014. <http://www.ncbi.nlm.nih.gov/pubmed/12618683>.