Korean J Pain.  2010 Mar;23(1):55-59.

Sympathetic Block for Treating Primary Erythromelalgia

  • 1Department of Anesthesiology and Pain Medicine, Kyungpook National University of Hospital, Daegu, Korea. painfree@gmail.com


Primary erythromelalgia is a rare condition that's characterized by erythema, an increased skin temperature and burning pain in the extremities. The pain is often very severe, and treating erythromelalgia is frustrating and difficult. We report here on the case of a 12-year old girl with primary erythromelalgia in both lower extremities. The pain was refractory to medical treatment, but a bilateral sympathetic block with lidocaine and triamcinolone resulted in relief from the pain. Our experience with this disease demonstrates that sympathetic blocks are effective in improving the symptoms and they may be attempted on erythromelalgia patients who do not respond to other treatments, including medication and epidural blocks.


erythromelalgia; sympathetic block

MeSH Terms

Lower Extremity
Skin Temperature


  • Fig. 1 The patient's feet at the time of visiting pain clinic.

  • Fig. 2 Lateral view of X-ray show spreading of mixture over L3 vertebral region in sympathetic ganglion block.


1. Rauck RL, Naveira F, Speight KL, Smith BP. Refractory idiopathic erythromelalgia. Anesth Analg. 1996; 82:1097–1101. PMID: 8610879.
2. Galimberti D, Pontón A, Rubio L, Torre A, Angles V, Soriano E, et al. A case of primary erythromelalgia. J Eur Acad Dermatol Venereol. 2009; 23:1338–1339. PMID: 19368608.
3. Cohen JS. Erythromelalgia: new theories and new therapies. J Am Acad Dermatol. 2000; 43:841–847. PMID: 11050591.
4. Park SK, Han KR, Lee YS, Hyun HS, Kim C. Epidural block of bupivacaine and mexiletine for erythromelalgia. Korean J Anesthesiol. 2001; 41:792–795.
5. Stricker LJ, Green CR. Resolution of refractory symptoms of secondary erythermalgia with intermittent epidural bupivacaine. Reg Anesth Pain Med. 2001; 26:488–490. PMID: 11561273.
6. D'Angelo R, Cohen IT, Brandom BW. Continuous epidural infusion of bupivacaine and fentanyl for erythromelalgia in an adolescent. Anesth Analg. 1992; 74:142–144. PMID: 1734777.
7. Waxman SG, Dib-Hajj SD. Erythromelalgia: a hereditary pain syndrome enters the molecular era. Ann Neurol. 2005; 57:785–788. PMID: 15929046.
8. Dib-Hajj SD, Rush AM, Cummins TR, Hisama FM, Novella S, Tyrrell L, et al. Gain-of-function mutation in Nav1.7 in familial erythromelalgia induces bursting of sensory neurons. Brain. 2005; 128:1847–1854. PMID: 15958509.
9. Natkunarajah J, Atherton D, Elmslie F, Mansour S, Mortimer P. Treatment with carbamazepine and gabapentin of a patient with primary erythermalgia (erythromelalgia) identified to have a mutation in the SCN9A gene, encoding a voltage-gated sodium channel. Clin Exp Dermatol. 2009; 34:E640–E642. PMID: 19549232.
10. Nathan A, Rose JB, Guite JW, Hehir D, Milovcich K. Primary erythromelalgia in a child responding to intravenous lidocaine and oral mexiletine treatment. Pediatrics. 2005; 115:E504–E507. PMID: 15741349.
11. Davis MD, O'Fallon WM, Rogers RS 3rd, Rooke TW. Natural history of erythromelalgia: presentation and outcome in 168 patients. Arch Dermatol. 2000; 136:330–336. PMID: 10724194.
12. Rudikoff D, Jaffe IA. Erythromelalgia: response to serotonin reuptake inhibitors. J Am Acad Dermatol. 1997; 37:281–283. PMID: 9270523.
13. Harrison CM, Goddard JM, Rittey CD. The use of regional anaesthetic blockade in a child with recurrent erythromelalgia. Arch Dis Child. 2003; 88:65–66. PMID: 12495966.
14. Weinstein SM, Herring SA. Lumbar epidural steroid injections. Spine J. 2003; 3(3 Suppl):37–44.
15. Seishima M, Kanoh H, Izumi T, Niwa M, Matsuzaki Y, Takasu A, et al. A refractory case of secondary erythermalgia successfully treated with lumbar sympathetic ganglion block. Br J Dermatol. 2000; 143:868–872. PMID: 11069475.
16. Shiga T, Sakamoto A, Koizumi K, Ogawa R. Endoscopic thoracic sympathectomy for primary erythromelalgia in the upper extremities. Anesth Analg. 1999; 88:865–866. PMID: 10195539.
17. Belch JL. Lowe GD, Tooke JE, editors. Temperature-associated vascular disorder-Raynaud's phonomenon and erythromelagia. A textbook of vascular medicine. 1996. London: Oxford University Press;p. 339–352.
18. Littleford RC, Khan F, Belch JJ. Skin perfusion in patients with erythromelalgia. Eur J Clin Invest. 1999; 29:588–593. PMID: 10411664.
19. Orstavik K, Mørk C, Kvernebo K, Jørum E. Pain in primary erythromelalgia-a neuropathic component? Pain. 2004; 110:531–538. PMID: 15288393.
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