Surgical sympathectomy, spinal cord stimulation, and central
neuraxial blockade have all been reported to be useful, but not rigorously tested. When superficial tactile
allodynia is a prominent feature of the patient’s presentation, this author has found that a diagnostic
lumbar paravertebral sympathetic block can be useful in assessing the degree of sympathetically mediated
pain. When sympathetically mediated pain is a prominent feature, as evidenced by over 50% pain reduction
with the sympathetic block, a percutaneous radiofrequency rhizotomy of the sympathetic chain can follow
for a more long-lasting effect.
By Timothy L. Sternberg, DMD, MD
Director, Center for Pain Management
University of Florida/Shands Jacksonville