There are times in which all of the nonsurgical methods fail to manage the pain and other symptoms of reflex sympathetic dystrophy and related disorders. It becomes time for the surgeon to step in and perform one of a set of procedures that have been found to improve the cure rate.

It helps to understand that the sympathetic nerves run their course from the brain to the far periphery of the body. In the soft tissue, stimulation of the sympathetic system causes increased blood flow to the muscles but decreased blood flow to soft tissue. It also affects the amount of sweating of the skin.

The surgeon can do one of several procedures. He or she can do a chemical sympathectomy, in which corrosive chemicals are used to block the sympathetic nerve chain. Implantable electrical stimulators can be used to block or stimulate the nerve at a specific site. If these don’t work, the surgeon can go in and cut the sympathetic fibers, releasing the tissue downstream from their influence.

If a peripheral sympathectomy doesn’t work, the surgeon can do an upper thoracic or lumbar sympathectomy, which cuts the affected nerves near the spinal cord. It can also be used in patients who have had a successful temporary blockade of the sympathetic nervous system and need a more permanent solution. Usually the patient has had up to five percutaneous sympathetic blocks but has had only temporary relief of pain.  The primary end result is relief of pain, although circulation is also improved, and range of motion of arms or legs, strength and functionality are all much better.

In a chemical sympathectomy, alcohol is used to ablate the sympathetic nerves. This is used if the patient is at high risk for surgery or when the doctor just wants to know if blocking the sympathetic nerve chain will work at all.

Research has shown that half of all patients get better even with non-operative treatment. Some, however, can relapse, even after several years. One study was done on patients with reflex sympathetic dystrophy. They were treated without surgery and 56 percent of them had significant recurrence of their symptoms. At the end of 5 years, 67 percent had a job change or lost their job directly because of the disease. Patients with operative treatment have a better result in the end.

In another study, 35 patients were referred for a surgical sympathectomy with RSD. Each had a diagnostic sympathetic block showing relief of symptoms at least temporarily. Excellent results were found after surgical sympathectomy in 74 percent of patients, with good results in 17 percent of patients and a poor result in 9 percent of patients. Three patients needed to have a repeat surgical cervical sympathectomy due to failure of the initial surgery. It is recommended to repeat the sympathectomy if the first one fails.