Endoscopic thoracic sympathectomy (ETS) has recently been used to treat chronic pain in the upper limbs. We conducted a survey to investigate the efficacy of ETS for treatment of chronic pain using a multicenter questionnaire in Japan. We sent questionnaires to 71 hospitals known to employ the procedure to block thoracic sympathetic trunks. Answers were received from 33 (46%) institutions, of which 12 (36%) had used ETS for treatment of a total of 35 patients suffering from chronic pain. The answers revealed that 60% of the patients experienced pain relief within 6 months of the ETS procedure, while 6 months or later, the percentage decreased to 34%. We concluded that ETS seemed to have, at best, temporary effect and should be carefully chosen as a method to treat chronic pain. There undoubtedly exists some close relation between pain and the sympathetic nervous system [1, 2], however, the hypothesis of sympathetic vasoconstrictor hyperactivity may not be generally applicable to chronic pain syndromes [3]. Therefore, simple application of a neuro-lytic sympathetic nerve block or surgical sympathectomy for some type of neuropathic pain is not recommended, even if it might provide temporary relief.
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