This injection can both diagnose and treat pain coming from the sympathetic nerves. It is a conventional treatment for shingles and complex regional pain syndromes affecting the head, face, neck, and arms. It can help treat and increase pain control of low blood flow states caused by neuropathy of the upper extremities. Usually, a series of these injections are needed to treat the problem.
This procedure is recommended for pain conditions caused by complex regional pain syndromes of the upper extremity, peripheral neuropathy, RSD of the upper extremity, facial pain, shingles in the head, face, neck and shoulder region, and some sympathetic nerve-mediated pain syndromes of the thoracic area.
The patient will be face up under fluoroscopy (x-ray) with a cushion under their shoulders to arch the neck in ‘hanging head over the edge’ type of position. The cushion brings the lower stellate ganglion area closer to the surface. The operator will feel and pull the muscles out of the way after injection local anesthesia in the skin to numb the area first. A needle will be placed through the numb skin and down to the stellate ganglion of the upper surface of the bone, using the x-ray as guidance. Contrast can be used to identify proper placement and then injection of local long-lasting anesthetic and steroid medications can be done in small intermittent doses while keeping contact with the patient.
Some patients get immediate relief of pain, and most will experience a change over time for longer lasting relief and return to a less painful state. Warmth increase in a cold extremity can be seen as well. The reflex of pain-producing decreased blood flow is mitigated with repeated blocks. The pain may recur in hopefully a lower level, and the injection may need to be repeated with a series of injections. The procedure can be used to both diagnosis and treat peripheral neuropathy, and it may also be used to indicate if the patient is a candidate for a cervical spinal cord stimulator trial.
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