Lumbar sympathetic and peripheral nerve minimally invasive pain intervention of refractory cold allodynia: A case report

Cold allodynia is a disabling neuropathic pain condition characterized by pain in response to non-noxious cold stimuli and is often refractory to pharmacological therapy. We report a case of a 51-year-old male with diabetes mellitus and cervical myelopathy presenting with severe bilateral lower limb cold allodynia. The patient showed minimal response to medical management. After evaluation, he underwent fluoroscopy-guided lumbar sympathetic minimally invasive pain and spine intervention (MIPSI) along with bilateral posterior tibial nerve block. The patient reported 60–70% relief within 24 h and sustained near-complete relief at 3-month follow-up, with only mild symptoms at very low temperatures. In conclusion, combined lumbar sympathetic and peripheral nerve MIPSI may provide effective and sustained relief in refractory cold allodynia. This multimodal approach targets both sympathetic and peripheral mechanisms and may represent a promising strategy in difficult-to-treat cases.