This highly controversial treatment involves the destruction of nerves using surgery or chemicals, and is indicated only for profoundly disabled patients who have responded positively to sympathetic blockade and have no other treatment options. Evidence to support the use of sympathectomy is limited, and as such its use is not widely recommended. Some retrospective studies of surgical sympothectomy have shown long-term success (Schwartzman, 1997; Kim, 2002; Brandyk, 2002). However, these successful outcomes should be balanced with reports
of the negative impact of surgical sympathectomy (Furlan, 2001).