International Journal of Advanced Engineering Research and Science (IJAERS) Peer-Reviewed Journal ISSN: 2349-6495(P) | 2456-1908(O) Vol-9, Issue-9; Sep, 2022 Journal Home Page Available: https://ijaers.com/ Article DOI: https://dx.doi.org/10.22161/ijaers.99.69 www.ijaers.com Page | 631 Sympathetic ablation combined to dorsal ganglion modulation was cost-effective for Complex Regional Pain Syndrome-1 Carlos A. F. Trindade, M.D., MSc 1 ; Célia S Oliveira, M.D. 1 ; Thiago S Serra, M.D. 1 , Helton A. Defino, M.D., MSc., Ph.D. 2 ; Gabriela R. Lauretti, M.D., M.Sc., Ph.D., FIPP 3,* 1 Postgraduate Student, Medical School of Ribeirão Preto, University of São Paulo (U.S.P.) 2 Professor of Orthopedics, Medical School of Ribeirão Preto, U.S.P, 3 Professor of Anesthesia and Interventional Pain Management, Medical School of Ribeirão Preto, U.S.P. *Corresponding author Received: 26 Aug 2022, Received in revised form: 20 Sep 2022, Accepted: 26 Sep 2022, Available online: 30 Sep 2022 ©2022 The Author(s). Published by AI Publication. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/). Keywords— Complex Regional Pain Syndrome-1, sympathetic block, dorsal ganglion, radiofrequency, central pain sensitization. Abstract — Sympathetic ablation combined to dorsal ganglion modulation was cost-effective for Complex Regional Pain Syndrome-1. Background: In Complex Regional Pain Syndrome-1 (CRPS), sympathetic ganglion block followed by radiofrequency (RF) is the treatment of choice. However, data suggest that dorsal ganglion (DG) is partly responsible for its central pain sensitization. The study aimed to evaluate the cost-effectiveness of central desensitization combined to either blocks or RF at the same levels. Methods: 36 patients with lower extremity CRPS-1 were randomly assigned to 1 of 2 Treatments (n=18). After effects of the first selected treatment receded, patients were crossed over to the second treatment. The treatments were : 1) test blocks followed by 4-weekly L3 sympathetic block + epidural sacral block or 2) test blocks followed by L3-L4-L5 sympathetic ablation + L3-L4-L5 DG modulation RF. Time of analgesia was defined as VAS>3cm. Patients acted as their own control related to analgesia, routine activities, sleep pattern and costs. Results: 24 patients completed the study. The analgesia time after the 4-weekly blocks were 5±1 months and the annual costs USA$5000. Analgesia time after RF was 15±2 months (p<0.001) and costs reduced by 23% in the first year and 32%-36% in the following years extrapolation. Quality of life and sleep pattern improved during the analgesia period (p> 0.05). Discussion: Sympathetic ganglion combined to DR RF at the same levels (L3-L4-L5) resulted in 15-month compared to 5-month analgesia after the classical 4-weekly blocks, and improved physical capacity and sleep pattern. It was cost-effective, and reduced rates by 23% during the first-year evaluation, followed by 32%- 36% cost reduction in following years, by extrapolation. I. INTRODUCTION When conservative pain management and physical rehabilitation fails in Complex Regional Pain Syndrome (CRPS)-1, the sequence of sympathetic block is the interventional treatment is part of treatment. For a lasting effect, sympathetic radiofrequency (RF) treatment is elected (2B+), 1 and the benefit of an early intervention is renowned in order to prevent long-term incapacity. 2 Inappropriately, RF is not included in all Health Systems,