Lumbar Sympathetic Block for resistant to treatment causalgia in patient with opioid dependence.

Abstract Background & Aim: Lumbar sympathetic block is a commonly used technique for sympathetically mediated pain in lower extrimity. Causalgia (CRPS type 2 ) is also accepted to be associated with sympathetic system activation. Treatment of this condition is difficult, especially when the patient has opioid dependency. there has not been any report regarding lower-extremity lumbar sympathetic block in patient with causalgia and drug dependency. Therefore, in this study, our experience of using lumbar sympathetic block on chronic and refractory pain of causalgia (CRPS type 2) in a patient with severe dependence on opioid drugs has been reported. Case Report: the patient is 36 years old male with crush injury in left lower extrimity who underwent lumbar sympathetic block for causalgia and score of  burning  pain is reduced  from 10 to 5  (NRS) and pain with quality of electric shock  (shooting) completely disappeared . the patientchr(chr('39')39chr('39'))s opioid was reduced by 50%. Conclusion: Lumbar sympathetic block could be considered in treatment of lower limb causalgia in patient with opioid dependency. More reports and controlled trials are needed for further understanding the role of long term efficacy of Lumbar sympathetic block.