Turn Off the Switch

Injection calms pain of hyperactive sympathetic nervous system.

Megan Stewart has been a pediatric speech-language specialist for more than 13 years. For the past two, she’s been helping students in the Duval County Public School System. On November 4 last year, Megan was the one needing help after she twisted her left ankle while jogging.

Photo by Nerissa Johnson.

Megan Stewart

“I went out for a run, stepped on a magnolia seed and rolled my ankle,” she discloses. “I was only a block or so away from home when I fell, so I was able to get home. Initially, the pain was just what you’d expect from rolling your ankle, but it got progressively worse as the evening went on.
“Eventually, it became a shooting, aching, burning pain – the most intense pain I’ve ever felt in my entire life. I’ve had three kids and two C-sections, so I’ve experienced some pain. This was debilitating. I couldn’t stand up and walk.”
With such excruciating pain, Megan suspected she’d hurt herself seriously. She went to the doctor the next day, and he discovered she’d broken a bone and torn three ligaments in her ankle. The injury significantly limited her mobility.
“I continued working, but I had to stop all additional physical activity,” she relates. “I was on crutches and was also given a knee scooter. I used that at work because the pain was so intense, I couldn’t put any pressure on my foot or ankle. Even shower water or the sheets on my bed touching my ankle increased the pain.
“I couldn’t do anything. I couldn’t play with my three sons. I couldn’t go outside and play with the dogs. I was basically laid up for three months. I’d go to work on my knee scooter, then come home and lie on the couch with my leg up to help alleviate the pain. I was down for the count.”
Megan underwent the typical treatment for her injury, including remaining non-weight-bearing, wearing an immobilization boot, taking anti-inflammatory medications and doing physical therapy. However, she never realized significant pain relief, and her ankle did not show the signs of improvement she expected.
“I kept getting that stabbing, shooting, burning pain,” she states. “My ankle felt like it was on fire, but it was very cold to the touch at the same time. It was bizarre. My ankle was also discolored and swollen.
“My orthopedic doctor suspected complex regional pain syndrome, so he sent me directly to Dr. McGreevy, who agreed with that diagnosis based on my symptoms, as well as an examination.”

Hyperactive Nerves

Kai McGreevy, MD, is a pain management specialist at McGreevy NeuroHealth in St. Augustine and Palm Coast.
Dr. McGreevy is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. He described the condition to Megan.
“Complex regional pain syndrome [CRPS] is a complicated disorder that often occurs after a crush injury and prolonged booting,” explains Dr. McGreevy. “It presents with a constellation of symptoms, including pain hypersensitivity, reduced range of motion, swelling, color and skin changes, and temperature changes in the affected extremity.

Photo by Nerissa Johnson.

Megan has no limitations on using her ankle.

“Megan was a classic case of CRPS. At our clinic, we do basic neurological testing and an extensive diagnostic workup on our patients. This is done in order to exclude other, treatable syndromes before we jump to the conclusion of CRPS.
“With CRPS, the sympathetic nervous system becomes hyperactive. It’s like turning on a switch, and the end result is chronic pain, but a special type of pain. With CRPS, even a very light touch, such as a cool breeze, can set off the very sensitive pain cycle.”
Dr. McGreevy had a recommendation to treat Megan’s CRPS. He suggested an effective tool called a lumbar sympathetic block (LSB), and Megan agreed to the procedure.

The Magic Shot

A lumbar sympathetic block is a minimally invasive procedure performed by injection under x-ray guidance, notes Dr. McGreevy. During an LSB, pain-relieving medication is guided to an area of the spine called the lumbar sympathetic plexus, which is a collection of nerves found at the region of the lumbar vertebrae L2, L3 and L4.
“The lumbar sympathetic plexus is where sensory, or feeling, symptoms are processed,” elaborates the doctor. “With an LSB, sensory information is blocked at that lumbar level of the spine, which prevents pain signals from getting to the brain. The result is reduced pain. Other symptoms of CRPS are also improved.”
“I just lay on my stomach on an examination table so Dr. McGreevy had access to my spine,” describes Megan. “He injected me with medication to numb the area. He used x-rays to make sure he was getting into the specific area in my spine where the particular nerves were located.”
Generally, the relief provided from an LSB lasts three to six months or longer. The treatment can be repeated if the symptoms of CRPS return, which doesn’t always occur. In some patients, the pain and other symptoms are reduced indefinitely. LSB is safely and easily performed by a qualified interventional pain management physician.
“With Megan, the diagnosis was very clear-cut,” confirms Dr. McGreevy. “I think that is one of the main reasons she had such a positive response to the LSB. A proper diagnosis is the most critical factor in whether a patient will have a chance at long-lasting relief and a return of function.”

Phenomenal Results

When Megan received her LSB, she responded quickly. Now, her ankle feels normal, and she’s back to all of her activities. She’s even back to running, but she watches more closely for magnolia seeds in her path.
“My results are amazing,” she marvels. “I started to get warm sensations in my ankle almost immediately, which was a big deal because during the whole process, it had been really cold. Within two weeks, I was feeling the full effect of the nerve block. I started getting increased range of motion in my ankle and was able to move it.

“I had phenomenal results from Dr. McGreevy and my lumbar sympathetic block. I couldn’t ask for anything better!” – Megan

“I soon had significantly decreased pain and was able to start putting pressure on my ankle and foot again. It was January 2017 when I had the procedure, and since then, I’ve had no side effects. I’ve been able to restart my exercise regimen and have had no relapses as far as pain. I have zero limitations.”
The outcome of her treatment thrilled Megan, but she’s also very pleased by the care she received from Dr. McGreevy. She describes him as very down-to-earth and interested in his patient’s needs and concerns.
“Dr. McGreevy is very caring,” she adds. “He takes the time to listen to his patients and listen actively and wholeheartedly, so you can tell he is really paying attention to what you’re saying. If he’s unclear of something or needs more information about what you’re describing, he asks follow-up questions. I never feel rushed when I’m in his office.”
After her positive experience, Megan has some words of recommendation to others in situations like hers. She suggests they seek Dr. McGreevy’s opinion and consider the LSB for pain relief.
“It’s like the shot was magic, and it took everything away,” she enthuses. “I’d tell people that if they have debilitating, life-altering pain and they have the opportunity, especially if Dr. McGreevy thinks it would help them, a sympathetic nerve block is definitely something to try.
“I had phenomenal results from Dr. McGreevy and my lumbar sympathetic block. I couldn’t ask for anything better!”

Print This Article
    • McGreevy Neuro Health

      Your neurological health is nothing to worry about when you visit McGreevy NeuroHealth, conveniently located between Saint Augustine and Jacksonville, Florida. Their facility hosts a qualified interventional pain physician who is also a board-ce... Read More

    • Kai McGreevy, MD

      Kai McGreevy, MD, is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. The American Board of Independent Medical Examiners also certifies him. His medical training includes completion of a neurolog... Read More