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Lumbar Sympathetic InjectionsFluoroscopically guided lumbar sympathetic blocks to interrupt sympathetically maintained pain in the leg — a key intervention for CRPS, phantom limb pain, and vascular pain at Remix Medical in Houston, TX.

Specialty
Pain Management
Type
Procedure
Body location
Lumbar sympathetic chain, L2-L4 vertebral bodies, lower extremity, sympathetic ganglia
CPT code
64520 (injection, anesthetic agent; lumbar or thoracic paravertebral sympathetic nerves); 77003 (fluoroscopic guidance, when reported separately); 64530 (celiac plexus, if applicable)

Also known as: Lumbar Sympathetic Injection, Sympathetic Nerve Block, Lumbar Sympathetic Chain Block, Sympathetic Blockade

Lumbar Sympathetic Block in Houston, Texas

Most pain travels along sensory nerves. Some does not. In certain conditions the sympathetic nervous system — the network that controls blood vessel tone, sweating, and the fight-or-flight response — becomes entangled in the pain circuit itself. The limb becomes cold, discolored, exquisitely sensitive to light touch, and the pain no longer bears any proportion to the original injury.

When that happens in a leg, a lumbar sympathetic block is both the test and the treatment.

What is a Lumbar Sympathetic Block?

The lumbar sympathetic chain is a bundle of nerves running along the front of the lumbar vertebrae. A lumbar sympathetic block places local anesthetic onto that chain under fluoroscopic guidance, temporarily interrupting sympathetic outflow to the leg.

If your pain drops substantially and the foot warms, the pain is sympathetically maintained — an important and treatable finding.

What It Treats

  • Complex Regional Pain Syndrome (CRPS) of the lower limb
  • Phantom limb pain and residual limb pain after amputation
  • Peripheral vascular disease with rest pain or non-healing ulcers
  • Post-herpetic neuralgia in a lumbar distribution
  • Diabetic peripheral neuropathy in selected refractory cases
  • Hyperhidrosis of the foot

Timing Matters

In CRPS, early intervention matters enormously. Sympathetic blocks performed within the first months of symptom onset — combined with aggressive physical therapy — are associated with better outcomes than the same blocks performed years later, once the condition has centralized.

The block is rarely a single event. A positive response is typically followed by a short series, paired with therapy that uses the analgesic window to restore movement in a limb the patient has stopped using.

Early Intervention at Remix Medical

A cold, discolored, exquisitely painful limb after an injury is not something to wait out. Contact Remix Medical to schedule a consultation with a board-certified pain management physician in Houston.

How it's performed

The patient lies prone under live fluoroscopy. After skin anesthesia, a needle is advanced alongside the anterolateral aspect of the L2, L3, or L4 vertebral body until it reaches the sympathetic chain. Contrast confirms correct spread along the chain and excludes vascular or intrathecal placement. Local anesthetic is injected, and skin temperature in the foot is monitored as an objective marker of successful sympathetic blockade.

How to prepare

Arrange a driver — you will not be able to drive afterward. Hold anticoagulants only as directed by the prescribing physician. Eat lightly. Wear loose clothing. Bring a record of your pain scores and any prior sympathetic block results.

What to expect after

Expect a warm foot and possible temporary leg heaviness for several hours. Do not drive until sensation and strength are fully normal. Schedule physical therapy to fall within the window of pain relief — this is the point of the block. Rise slowly from sitting for the first day, as blood pressure may drop. Report fever, back pain, groin numbness, or new leg weakness immediately.

Outcome

A successful block produces immediate warming of the foot and substantial pain reduction, confirming sympathetically maintained pain. Relief typically lasts hours to weeks and is used to enable intensive physical therapy, which is what drives durable functional recovery in CRPS.

Your physician

Your pain management at Remix Medical.

Every clinician at Remix Medical is board-certified and owns the practice — so the physician in your exam room is the one making decisions about your care.

  • Raju Mantena, DO

    Pain Medicine Physician

    Medical Center — South Freeway · Montrose — Upper Kirby · Pearland

    Board certifiedAccepting newBook

This page is for general education and is not a substitute for medical advice. Whether a given procedure is appropriate depends on your individual evaluation. Contact a Remix Medical clinician to discuss your care.

Updated July 9, 2026.

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