Lumbar Sympathetic Block

A lumbar sympathetic block is an injection of medication that helps relieve lower back or leg pain (sciatica). Sympathetic nerves are located on both sides of the lumbar (lower) spinal column. A steroid medication and local anesthetic injected into or around your sympathetic nerves can help reduce pain in that area.

The sympathetic nerves are part of the autonomic nervous system, and are responsible for various functions including blood pressure, digestion, sweating and heart rate. Following an injury or severe trauma, these nerves can occasionally still transmit pain signals, even after the injury has healed. When this happens, the patient will suffer from Reflex Sympathetic Dystrophy (RSD), also called Complex Regional Pain Syndrome (CRPS).

What is a lumbar sympathetic block?

A lumbar sympathetic block is used to block the signal from the nerves that are causing you to suffer. If effective, it will reduce the discoloration of the skin, swelling, pain, and sweating associated with the RSD and CRPS. The procedure includes an injection of anesthetics into the sympathetic nerves believed to be causing your pain.

During the injection you will be awake, but your doctor will numb the skin before inserting the injection into the nerves. Once the skin is numbed, your doctor will use X-ray guidance to ensure the needle will go directly into the nerves along the outside of the spine. To confirm, they will inject a contrast dye which will use the X-ray to show the anesthetic will go into the correct area. The actual injections to the nerve will take place slowly, over the course of several minutes. Your doctor will continue using the X-ray to ensure the medication injected is going to the correct areas.

What happens afterward?

After the lumbar sympathetic block, you should notice a significant decrease in pain. Since this procedure involves injecting anesthetic into nerves, it is recommended that you have someone waiting to drive you home afterward. Your doctor will advise you to rest and only perform the light activities you can handle for a few days. You may also start physical therapy in the days following the injection. 

After the first sympathetic nerve block, the nerves will be blocked for several hours. Typically, the duration of the blockage will increase after each injection. If the initial injection is successful in blocking your pain, you can continue to repeat them for as long as necessary; some patients return 2-4 times, while others require 10 or more. The effects are different for each person. Patients who have their first sympathetic nerve block soon after their pain symptoms begin will generally not need as many injections as those who have been in pain for longer periods of time.

A lumbar sympathetic block may be right for you if you have lower back or leg pain which does not respond to other treatment. A doctor at Integrated Pain Management will be happy to discuss all of the best options available to relieve your pain.