Procedure

Sympathetic Nerve Blocks

Sympathetic nerve blocks are a family of targeted injections that interrupt pain signals carried by the sympathetic nervous system — addressing pain in the extremities, trunk, abdomen, and pelvis that has not responded to other treatments.

Overview

How Sympathetic Nerve Blocks Work

The sympathetic nervous system is a network of nerves that runs alongside the spine and controls many automatic body functions — including blood vessel tone, sweating, and in some cases, pain transmission. In conditions like complex regional pain syndrome (CRPS), cancer pain, and certain visceral pain disorders, the sympathetic nervous system becomes abnormally involved in generating or maintaining pain signals. Sympathetic nerve blocks interrupt this pathway by delivering medication precisely to the nerve cluster responsible for the affected region.

Each type of sympathetic block targets a different anatomical location and is selected based on where the pain is located and what condition is being treated. All blocks are performed using image guidance — typically fluoroscopy or ultrasound — to ensure precise and safe needle placement. They are same-day outpatient procedures. A consultation with our clinical team will determine whether you are a candidate.

Types of Sympathetic Blocks

The Blocks We Perform

Stellate Ganglion Block

The stellate ganglion is a collection of sympathetic nerves located in the neck. A stellate ganglion block is used for pain affecting the head, neck, chest, and upper extremities — and is one of the primary sympathetic interventions for upper extremity CRPS. It may also be considered for certain neuropathic pain conditions affecting the face and upper body.

Lumbar Sympathetic Block

The lumbar sympathetic chain runs alongside the lower spine and transmits pain signals from the lower extremities. A lumbar sympathetic block is used for lower extremity CRPS, peripheral vascular disease-related limb pain, and other sympathetically maintained pain conditions affecting the legs and feet.

Celiac Plexus Block

The celiac plexus is a network of sympathetic nerves in the upper abdomen that carries pain signals from abdominal organs including the pancreas, stomach, liver, and intestines. A celiac plexus block is commonly used for pain from pancreatic cancer, chronic pancreatitis, and other upper abdominal pain conditions that have a visceral component.

Splanchnic Nerve Block

The splanchnic nerves carry sympathetic pain signals from the abdominal organs to the celiac plexus. A splanchnic nerve block targets these nerves at a higher level than a celiac plexus block and may be used for similar visceral abdominal pain conditions, particularly in patients for whom celiac plexus access is technically more challenging.

Superior Hypogastric Plexus Block

The superior hypogastric plexus transmits sympathetic pain signals from the pelvic organs — including the bladder, uterus, ovaries, prostate, and rectum. A superior hypogastric plexus block is used for chronic pelvic pain, endometriosis-related pain, and pelvic cancer pain that has a sympathetic component.

Ganglion Impar Block

The ganglion impar is a small sympathetic ganglion located at the tip of the coccyx (tailbone). A ganglion impar block is used for coccygodynia (tailbone pain), perineal pain, and certain pelvic or rectal cancer pain conditions affecting the midline pelvic structures.

Recovery & Results

What to Expect After a Sympathetic Block

Sympathetic nerve blocks are same-day outpatient procedures — patients go home the same day and most return to normal activity within one to two days. It is common to experience some temporary warmth, heaviness, or altered sensation in the treated area immediately after the procedure, which reflects the normal response to sympathetic interruption and typically resolves within hours.

The duration of pain relief varies by patient, condition, and block type. Some patients experience relief lasting days to weeks from a single injection. Others benefit from a series of blocks, with each one providing progressively longer relief. In certain cases — particularly for cancer-related visceral pain — neurolytic agents can be used to provide longer-lasting interruption of the pain pathway. Many patients find that relief outlasts the duration of the local anesthetic itself, which is thought to reflect a reset of the abnormal sympathetic pain cycle.

Frequently Asked Questions

Common Questions

Sympathetic nerve blocks are used for a range of conditions in which the sympathetic nervous system is contributing to pain — including complex regional pain syndrome (CRPS), cancer-related pain, visceral abdominal pain, pelvic pain, coccygodynia, and certain neuropathic pain conditions. The specific block used depends on the location and nature of the pain.
The duration of relief varies depending on the type of block, the medication used, and the individual patient. Some patients experience relief lasting days to weeks from a single injection, while others benefit from a series of blocks. In some cases, neurolytic agents can be used to provide longer-lasting interruption of the sympathetic nerve pathway. Relief from sympathetic blocks often outlasts the duration of the local anesthetic itself, which is thought to reflect a reset of the abnormal sympathetic pain cycle.
Most patients tolerate sympathetic nerve blocks well. The procedure is performed using image guidance — typically fluoroscopy or ultrasound — to ensure precise needle placement. A local anesthetic is used to minimize discomfort at the injection site. Some patients experience mild soreness or a temporary warm sensation in the treated area afterward, which is a normal response to sympathetic interruption.
The location of your pain generally determines which sympathetic block is most appropriate. Upper extremity and neck pain typically responds to a stellate ganglion block. Lower extremity pain — particularly in CRPS — is addressed with a lumbar sympathetic block. Abdominal and visceral pain from cancer or pancreatitis may benefit from a celiac plexus or splanchnic nerve block. Pelvic pain is often addressed with a superior hypogastric plexus block, and coccygeal or perineal pain with a ganglion impar block. A thorough evaluation determines the best approach for your specific situation.
Yes. Sympathetic nerve blocks can be performed as a series when a single injection provides temporary but meaningful relief. The number and frequency of blocks depends on the individual patient’s response and the underlying condition being treated. For patients who respond well to repeated blocks, longer-lasting neurolytic options may also be considered.

Schedule a Consultation

A consultation is the right starting point. Our clinical team will review your history and determine whether a sympathetic nerve block is an appropriate next step for your pain.

Request an Appointment (850) 559-2355