Lumbar Sympathetic Block for Palliation.

[Percy-Zanger]

  I am a retired phsician with adhesive lumbar arachnoiditis, resulting from multiple spine surgeries. So far pharmacologic treatment, including tirals on almost all anti-convusants, antidepressants, baclofen and clonazepam, has failed. I am now seeing a pain management specialist (anesthesiologist) who proposes a series of 2 or 3 lumbar sympathetic blocks (actually epidural anesthesia).  He says some patients will get amelioration of pain for a time following this proceedure. The theory being that it may block the "pain memory in the nerves. Have you heard of this? Is it standard practice?  Does it ever work?  Would appreciate you answer
  
  Percy Zanger, M.D..
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Hello Dr. Zanger!!
Let me first apologize for our protracted delay in answering your question. Arachnoiditid as you well know by now is an extremely difficult to treat cause of chronic pain. The logic of epidural corticosteroids and local anesthetics is simply to deliver a much more concentrated amount of relief into a smaller area where the actual problem is going on, much the same way a rheumatologist might inject a knee with osteoarthritis with a cortisone injection. It will not "cure" the arachnoiditis, as the scar tissue is usually permanent, but may offer a more durable and effective means of pain control for up to months at a time once/if an effective dose can be determined. If all other p.o. meds have failed you at this point, it sounds like a reasonable option. I'm less certain about the claim of "erasing" the "pain memory" in the affected nerve roots, especially since some recent neuroscience research suggests that such "memories" may be stored centrally in the brain itself irrespective of the initial point of generation of the pain transmission in the peripheral nervous system. If you would be interested in a second look by one of our spine center physicians, we'd of course be happy to evaluate you. Our number is 1-800-223-2273. Good Luck in your efforts to combat this very challenging problem. Please remember we are providing information on the forum as a public service and that it is intended for general informational purposes only. The actual treatment of your specific illness should continue to be with your current treating physician(s).