Lumbar Sympathetic Blocks

The sympathetic nervous system is a prime force in regulating one’s central nervous system. Our pain specialists use sympathetic blocks to re-route pain signals so our clients can experience lessened chronic nerve pain. This procedure targets the lumbar area, effectively restoring comfort in the client’s low, mid-back and leg regions.

What is a Lumbar Sympathetic Block?

A lumbar sympathetic block is an injection in the middle of the lower back, toward the left or right side. The “lumbar sympathetic nerves” are a small bundle of nerves that carries “sympathetic” nerve signals from the lower extremities. In some instances, certain injuries to the lower extremities can cause a burning, unusual pain called complex regional pain syndrome or reflex sympathetic dystrophy. Injecting a small amount of local anesthetic on the lumbar sympathetic nerves can identify whether or not this pain is carried by the sympathetic nervous system.

Lumbar Sympathetic Blocks

How It Works

The SNS is known to play a role in neuropathic pain,[2] and the sympathetic block has proved invaluable in handling several hard-to-treat syndromes. Sympathetic blocks can be used for diagnostic, prognostic and therapeutic purposes.[3]

  1. Diagnostic: To determine if the pain is sympathetically mediated or not.
  2. Prognostic: To determine if a neurolytic procedure (i.e. radiofrequency ablation or chemoneurolysis) would be beneficial.
  3. Therapeutic: To treat a variety of conditions.

The target for a lumbar sympathetic block is the sympathetic chain and ganglia located immediately anterior to the vertebral bodies of the lumbar spine. Typically, the ganglion located immediately adjacent to the L2 vertebra is the most common site of injection for this procedure.

How is a lumbar sympathetic block done?

First, you’ll be given an intravenous medication to relax you. Then, you’ll lie on your stomach on an x-ray table.

The doctor will numb an area of skin on your lower back with a local anesthetic. Then, guided by an x-ray, he or she will:

  • Insert a needle into your back, along the outside of your spine
  • Inject dye to confirm that medication will go to the correct spot
  • Inject a steroid medication

Usually, the procedure takes less than 30 minutes, and you can go home the same day.


Here are answers to some frequently asked questions related to Lumbar Sympathetic Block.

What are the Benefits of a Lumbar Sympathetic Block?

A lumbar sympathetic block is one of the most effective weapons in a pain management doctor’s arsenal. It is a minimally invasive treatment option with the potential to relieve pain when other more conventional therapies have failed. One of the most impressive things about this injection is its ability to offer immediate pain relief and allow patients to participate in physical therapy, returning them to their normal daily activities sooner. It can be used to diagnose and treat many types of pain that are non-responsive to conventional therapies: CRPS,[4] phantom limb pain,[1] postherpetic neuralgia,[5] ischemic limb pain,[6] and cancer pain.[7]
Regardless of the outcome of the procedure, your physician will be able to determine what part, if any, the SNS plays in the perpetuation of certain pain processes. In cases were there is temporary relief from a lumbar sympathetic block, a diagnosis of sympathetically-mediated pain can be established and guide further treatment – increasing the chances of success.

How Many Treatments Will I Need?

The amount of treatments varies on the severity of the pain and the length of time it has been present.


When will I feel better?

After a successful blockade of the sympathetic nervous system there will be an increase in skin temperature most describe as a sensation of warmth coming over the leg on the side of the procedure. This is the indication of a successfully performed sympathetic block. 
After the procedure is completed there are several possible outcomes:

  1. Your pain is improved or even eliminated for several days after the effect of the anesthetic wears off. This indicates the procedure had an obvious therapeutic value and offers some insight into the process causing pain, guiding the future treatment plan to maximize pain control.
  2. There is the sensation of warmth in the leg (evidence of a successful sympathetic blockade), however there is no pain relief. This means the block was successful however the lack of pain relief will be of diagnostic value to your doctor. This will equally guide your physician’s decision making when coming up with future treatment plans.
  3. There is no sensation of warmth in the leg and there is no pain relief. This indicates the block was not performed correctly and may need to be repeated to properly assess whether or not the pain is driven by the sympathetic nervous system.
Is a Lumbar Sympathetic Block Right for Me?

If you suffer from chronic pain that has failed to resolve with medications, physical therapy, and other conservative therapies, this treatment may be an option for you. A lumbar sympathetic block should only be performed under the strict supervision of a board-certified pain management specialist.

If you have any other questions about our Lumbar Sympathetic Block, or you need more clarity on the procedure before setting an appointment, please don’t hesitate to contact us.