22nd Annual Pain Medicine Meeting 2023

Traditionally, lumbar sympathetic blocks are utilized for the treatment of a variety conditions resulting in chronic lower extremity pain, such as:

vComplex regional pain syndrome

vPhantom limb pain

vPain of vascular insufficiency

vPost herpetic neuralgia

In this case, a patient with diabetic lumbosacral radiculoplexus neuropathy received a lumbar sympathetic block, which is not a standard treatment for this condition, with at least 3 months of significant pain reduction.

Diabetic Lumbosacral Radiculoplexus Neuropathy

(Diabetic Amyotrophy)

Symptoms

•Typically, unilateral lower extremity

•Neuropathic pain, weakness, and paresthesia consistent with femoral and/or obturator nerve distribution

Etiology

•Affecting <1% of diabetic patients

•Diagnosed with electromyography (EMG)

Treatment

•Conservative medical management

Limited treatment options for refractory pain

A 58-year-old female with history of T2DM, was admitted to the hospital in September 2022 with right-sided weakness and foot drop, which progressed bilaterally.

vEMG confirmed bilateral Diabetic Amyotrophy

vAfter 2 weeks, discharged to an Acute Rehabilitation

vDespite medications and rehabilitation, she had minimal improvement in pain levels and weakness

In December of 2022, she presented to pain clinic.

Chief complaint

vBilateral leg pain and weakness, left greater than right

•

On physical exam strength:

v1/5 in bilateral knee extensors

v0/5 in bilateral dorsiflexors and extensor hallucis longus

vSevere bilateral lower extremity allodynia

•

In February 2023, we proceeded with a right L3 lumbar sympathetic block, (Figure 1).

vFluoroscope guided

vOmni Paque 180 confirmed needle placement

v10mL of 0.25% of bupivacaine injected

vThe procedure was well tolerated without complications

At her 3 month follow up visit after the right L3 block

vShe reported a 70% reduction in RLE pain

vLeft lower extremity pain was unchanged

On physical exam strength was:

v5-/5 bilateral hip flexors and knee extensors

v3/5 bilateral distal musculature

A decision was made to repeat the sympathetic block on the left side.

At her 2 month follow up, after the left L3 block

vShe reported a 70% improvement in LLE pain

vMuscle strength at that visit remained unchanged from her prior visit.

Lumbar sympathetic blocks in this case provided significant reduction in this patient's pain due to diabetic lumbosacral radiculoplexus neuropathy.

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Future studies may be beneficial to look at the efficacy of this treatment for diabetic amyotrophy.

22nd Annual Pain Medicine Meeting 2023

FROM AGONY TO AGILITY: SYMPATHETIC BLOCK RELIEVING DIABETIC AMYOTOPHIC PAIN IN AN ADULT

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