Sympathectomy (cutting the sympathetic nerves)
Sympathectomy is done surgically, chemically or by radioablation. There is a recent Cochrane systematic review that concluded: “The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options. In these circumstances, establishing a clinical register of sympathectomy may help to inform treatment options on an individual patient basis.”
It has been argued that since most children do well with conventional therapies (exercise therapy and counseling) invasive therapies should be avoided.
- Straube S, Derry S, Moore RA, Cole P. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev. 2013 Sep 2;9:CD002918. doi: 10.1002/14651858.CD002918.pub3.
- Zernikow B, Dobe M, Hirschfeld G, Blankenburg M, Reuther M, Maier C. [Please don’t hurt me!: a plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)]. Der Schmerz 2012;26:389-95.