07/01/2025
I have seen several chronic pain patients over the years with predominantly flank pain baring the diagnosis of Nutcracker syndrome, a rare diagnosis that should never be overlooked!
Nutcracker syndrome, characterized by compression of the left renal vein between the aorta and the superior mesenteric artery, can result in debilitating flank pain, hematuria, and pelvic congestion. While definitive vascular interventions remain the mainstay of treatment, many patients experience significant chronic pain that is either not amenable to immediate surgical correction or persists even after vascular decompression.
Interventional pain medicine can play a crucial role in these complex cases. By targeting the sympathetic and visceral pain pathways, interventions such as superior hypogastric plexus blocks, celiac plexus blocks, splanchnic nerve blocks, and even neuromodulation techniques can provide meaningful relief and restore function. These procedures can help patients bridge the gap to definitive therapy, minimize opioid requirements, and address neuropathic pain components that often accompany visceral congestion syndromes.
As interventional pain specialists, it is vital for us to be aware of these options and collaborate with vascular colleagues to offer a multimodal and patient-centered approach for Nutcracker syndrome.
