Testing the link between sympathetic efferent and sensory afferent fibers in neuropathic pain

Srinivasa Naga Raja, Rolf Detlef Treede

Research output: Contribution to journalArticle

Abstract

Systemic α-adrenergic Blockade with Phentolamine: A Diagnostic Test for Sympathetically Maintained Pain. By S. N. Raja, R. D. Treede, K. D. Davis, and J. N. Campbell. ANESTHESIOLOGY 1991; 74:691-8. Reprinted with permission. ABSTRACT:: The diagnosis of sympathetically maintained pain (SMP) is typically established by assessment of pain relief during local anesthetic blockade of the sympathetic ganglia that innervate the painful body part. To determine if systemic α-adrenergic blockade with phentolamine can be used to diagnose SMP, we compared the effects on pain of local anesthetic sympathetic ganglion blocks (LASB) and phentolamine blocks (PhB) in 20 patients with chronic pain and hyperalgesia that were suspected to be sympathetically maintained. The blocks were done inrandom order on separate days. Patients rated the intensity of ongoing and stimulus-evoked pain every 5 min before, during, and after the LASB and PhB. Patients and the investigator assessing pain levels were blinded to the time of intravenous administration of phentolamine (total dose 25-35 mg). The pain relief achieved by LASB and PhB correlated closely (r = 0.84), and there was no significant difference in the maximum pain relief achieved with the two blocks (t = 0.19, P > 0.8). Nine patients experienced a greater than 50% relief of pain and hyperalgesia from both LASB and PhB and were considered to have a clinically significant component of SMP. We conclude that α-adrenergic blockade with intravenous phentolamine is a sensitive alternative test to identify patients with SMP.

Original languageEnglish (US)
Pages (from-to)173-177
Number of pages5
JournalAnesthesiology
Volume117
Issue number1
DOIs
StatePublished - Jul 2012

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Neuralgia
Phentolamine
Pain
Sympathetic Ganglia
Local Anesthetics
Adrenergic Agents
Hyperalgesia
Pain Measurement
Human Body
Routine Diagnostic Tests
Chronic Pain
Intravenous Administration
Research Personnel

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Testing the link between sympathetic efferent and sensory afferent fibers in neuropathic pain. / Raja, Srinivasa Naga; Treede, Rolf Detlef.

In: Anesthesiology, Vol. 117, No. 1, 07.2012, p. 173-177.

Research output: Contribution to journalArticle

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