Straube Sebastian, Derry Sheena, Moore R Andrew, McQuay Henry J
Department of Occupational and Social Medicine, University of Göttingen, Waldweg 37 B, Göttingen, Germany, D-37073.
Cochrane Database Syst Rev. 2010 Jul 7(7):CD002918. doi: 10.1002/14651858.CD002918.pub2.
This review is an update on 'Sympathectomy for neuropathic pain' originally published in Issue 2, 2003. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using thermal or laser interruption.
To review the evidence from randomised, double blind, controlled trials on the efficacy and safety of chemical and surgical sympathectomy for neuropathic pain. Sympathectomy could be compared with placebo (sham) or other active treatment.
We searched MEDLINE, EMBASE and The Cochrane Library to May 2010. We screened references in the retrieved articles and literature reviews, and contacted experts in the field of neuropathic pain.
Randomised, double blind, placebo or active controlled studies assessing the effects of sympathectomy for neuropathic pain and CRPS.
Two review authors independently assessed trial quality and validity, and extracted data. No pooled analysis of data was possible.
Only one study satisfied our inclusion criteria, comparing percutaneous radiofrequency thermal lumbar sympathectomy with lumbar sympathetic neurolysis using phenol in 20 participants with CRPS. There was no comparison of sympathectomy versus sham or placebo. No dichotomous pain outcomes were reported. Average baseline scores of 8-9/10 on several pain scales fell to about 4/10 initially (1 day) and remained at 3-5/10 over four months. There were no significant differences between groups, except for "unpleasant sensation", which was higher with radiofrequency ablation. One participant in the phenol group experienced postsympathectomy neuralgia, while two in the radiofrequency group and one in the phenol group complained of paresthaesia during needle positioning. All participants had soreness at the injection site.
AUTHORS' CONCLUSIONS: The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options.
本综述是对2003年第2期发表的“交感神经切除术治疗神经性疼痛”的更新。许多神经性疼痛综合征（传统上，这一定义包括复杂性区域疼痛综合征（CRPS））是“交感神经维持性疼痛”这一概念，在历史上导致了中断交感神经系统的治疗方法。化学性交感神经切除术使用酒精或苯酚注射来破坏交感神经链的神经节，而手术切除则通过开放切除或电凝交感神经链，或采用热或激光中断的微创手术来进行。
回顾关于化学性和手术性交感神经切除术治疗神经性疼痛的疗效和安全性的随机、双盲、对照试验证据。交感神经切除术可与安慰剂（假手术）或其他积极治疗进行比较。
我们检索了截至2010年5月的MEDLINE、EMBASE和考克兰图书馆。我们筛选了检索到的文章和文献综述中的参考文献，并联系了神经性疼痛领域的专家。
评估交感神经切除术治疗神经性疼痛和CRPS效果的随机、双盲、安慰剂或积极对照研究。
两位综述作者独立评估试验质量和有效性，并提取数据。无法进行数据的汇总分析。
只有一项研究符合我们的纳入标准，该研究在20例CRPS患者中比较了经皮射频热腰椎交感神经切除术与使用苯酚的腰椎交感神经松解术。没有对交感神经切除术与假手术或安慰剂进行比较。未报告二分法疼痛结局。在几个疼痛量表上，平均基线评分8 - 9/10最初（1天）降至约4/10，并在四个月内维持在3 - 5/10。除了“不愉快感觉”外，两组之间没有显著差异，射频消融组的“不愉快感觉”更高。苯酚组有1名参与者出现交感神经切除术后神经痛，而射频组有2名、苯酚组有1名参与者在针刺定位期间抱怨有感觉异常。所有参与者在注射部位都有酸痛感。
手术和化学性交感神经切除术治疗神经性疼痛和CRPS的做法所依据的高质量证据非常少。在临床实践中，交感神经切除术应谨慎使用，仅适用于经过仔细挑选的患者，并且可能仅在其他治疗选择失败后使用。
