Some clinical observations suggest that outcome is improved if sympathetic nerve block is performed as early as possible. Treatment Anesthetic or pharmacologic blockade of sympathetic nerve function and physical therapy are the most important modalities if the syndrome is sympathetically maintained. If it is not, interventions directed at the sympathetic nervous system should not be continued. Pain relief that outlasts the pharmacologic effect of the block but is transitory despite repeated temporary blocks suggests the need for surgical or chemical sympathectomy. Regional sympathetic blockade with IV guanethidine, reserpine, or bretylium, a specialized anesthetic technique, may be useful for selected patients.
Physical therapy is essential throughout therapy.
If myofascial trigger points are present, injection with local anesthetic or saline should be considered. No studies have established that one form of neuroaugmentative therapy is superior to another or that a poor response to one form means a poor response to other forms. Thus, treatment remains empiric. Psychologic therapies are described below. All rights reserved.