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There are 2 types of sympathectomy:

• Chemical sympathectomy
• Surgical sympathectomy

Chemical Sympathectomy

During a chemical sympathectomy, a neurolytic agent (a chemical that destroys nerve cells) is injected into the sympathetic ganglion at a specific site to block sympathetically-maintained pain. Phenol and ethanol are the two most frequently used neurolytic agents for chemical sympathectomy.

Potential complications of chemical sympathectomy include:

• Post sympathectomy pain
• Paralysis
• Neuritis - inflammation of a nerve due to irritation from the phenol or ethanol

Surgical Sympathectomy

A surgical sympathectomy involves cutting and cauterizing (sealing) the nerves of the sympathetic ganglion at a specific location along the spinal cord. There are various techniques that may be used to perform a surgical sympathectomy, including video-assisted surgery, open surgery, or radiofrequency sympathectomy.

Following a surgical sympathectomy, the patient may experience complete pain relief, partial pain relief, or no pain relief. In general, many patients experience complete or partial pain relief for several months following a surgical sympathectomy but only about 15% to 30% experience long-term relief lasting two years or longer.

In a study published in 2002 in the Journal of Vascular Surgery, researchers from the University of South Florida College of Medicine reported that approximately 90% of patients with RSD in their study who underwent surgical sympathectomy reported at least a 50% reduction in pain intensity, although the level of pain reduction deteriorated over time. Ten percent of the patients in this study were considered treatment failures. A significant subset of the total patients regretted having undergone the procedure due to subsequent reported high levels of disability. Overall patient satisfaction was 77%.

You can read more about this study by clicking on the following link: http://www.ncbi.nlm.nih.gov/pubmed/11854724

Potential complications of surgical sympathectomy include:

• Post-sympathectomy pain - pain associated with the surgical procedure which has been reported to occur in about 40% of patients
• Compensatory hyperhidrosis - excessive sweating of the face, trunk, or legs
• Recurrence of RSD pain
• Pneumothorax - accidental injury to the lung (for upper body RSD)
• Horner's syndrome - a syndrome caused by injury to the sympathetic nerves of the face which includes a constricted pupil, drooping eyelids, and facial dryness
• Reduced blood pressure when standing (postural hypotension)

Generally, there is debate about this procedure in the medical community for several reasons, including:

• Significant complications
• Procedure does not sufficiently enhance the effectiveness of physical or occupational therapy
• Lack of well designed randomized controlled clinical trials proving efficacy of this procedure
• Key role of the sympathetic nervous system in RSD is being increasingly challenged

Spinal Cord Stimulation

Another treatment option for patients with RSD is the use of electrical nerve stimulators that apply a small amount of electrical current to the nerves to overcome the sensation of pain. This type of treatment is known as spinal cord stimulation (SCS).

A spinal cord stimulator is a device that consists of a power source, leads (wires), and an external controller. A small wire, called a lead, is surgically implanted into the epidural space of the spinal column and is connected to a power source and an external unit controlled by the patient. When the patient initiates the flow of electrical current from the external unit, low-level electrical impulses are transmitted through the lead wire to the spinal cord to interrupt and block pain. Spinal cord stimulation affects the entire central nervous system. Peripheral nerve stimulators (PNS) are similar to spinal cord stimulators with the difference being that the electrodes are placed outside the central nervous system and they target only the peripheral nervous system.