Endoscopic electrocautery of the upper thoracic sympathetic chain: a safe and simple technique for treatment of sympathetically maintained pain.

Transthoracic endoscopic electrocautery of the upper thoracic ganglia was applied to seven patients with sympathetically maintained pain (SMP) in the upper extremity, diagnosed by local anaesthetic stellate ganglion blocks. The mean (SD) pain intensity of 67 (13) mm as evaluated by means of a visual analogue scale was reduced by 79 (27%) postoperatively and this effect persisted after 3 months. Long term follow up comprises two patients so far (one year and two years, respectively) who have had no recurrence of SMP. No complications occurred. The operation was found to be fast, safe and effective and it highlights the enigmatic role of the sympathetic nervous system in chronic pain.