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Singh H, Rajarathinam M. Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions. J Anaesthesiol Clin Pharmacol 2024; 40:185-191. [PMID: 38919437 PMCID: PMC11196062 DOI: 10.4103/joacp.joacp_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 06/27/2024] Open
Abstract
Cervical sympathetic or stellate ganglion blocks (SGBs) have been commonly used in the treatment of painful conditions like complex regional pain syndrome (CRPS). However, there is literature to suggest its utility in managing non-painful conditions as well. The focus of this literature review is to provide an overview of indications for SGB for painful and non-painful conditions. We identified published journal articles in the past 25 years from Embase and PubMed databases with the keywords "cervical sympathetic block, stellate ganglion blocks, cervical sympathetic chain, and cervical sympathetic trunk". A total of 1556 articles were obtained from a literature search among which 311 articles were reviewed. Among painful conditions, there is a lack of evidence in favor of or against the use of SGB for CRPS despite its common use. SGB can provide postoperative analgesia in selective surgeries and can be effective in temporary pain control of refractory angina and the acute phase of herpes zoster infection. Among non-painful conditions, SGB may have beneficial effects on the management of post-traumatic stress disorder (PTSD), refractory ventricular arrhythmias, hot flashes in postmenopausal women, and breast cancer-related lymphedema. Additionally, there have been various case reports illustrating the benefits of SGB in the management of cerebral vasospasm, upper limb erythromelalgia, thalamic and central post-stroke pain, palmar hyperhidrosis, orofacial pain, etc. In our review of literature, we found that SGB can be useful in the management of various non-painful conditions beyond the well-known treatment for CRPS, although further studies are required to prove its efficacy.
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Affiliation(s)
- Heena Singh
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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Khan SJ, Kapoor E, Faubion SS, Kling JM. Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives. Int J Womens Health 2023; 15:273-287. [PMID: 36820056 PMCID: PMC9938702 DOI: 10.2147/ijwh.s365808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/18/2023] [Indexed: 02/16/2023] Open
Abstract
Vasomotor symptoms affect as many as 80% of midlife women, but only about one in four women receive treatment due to many factors. Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms, and current professional guidelines conclude that the benefits of treatment typically outweigh the risks for healthy, symptomatic women under age 60 years and those within 10 years from their final menstrual period. For women with medical comorbidities, an individualized approach to treatment is recommended. For women who cannot use or choose not to use menopausal hormone therapy, there are many evidence-based non-hormonal options available including pharmacologic therapies. This review aims to summarize treatment options for bothersome vasomotor symptoms to guide clinicians caring for midlife women.
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Affiliation(s)
- Saira J Khan
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ekta Kapoor
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Juliana M Kling
- Mayo Clinic Women’s Health, Rochester, MN, USA,Division of Women’s Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA,Correspondence: Juliana M Kling, Division of Women’s Health Internal Medicine, Mayo Clinic, 13737 N 92 23 nd St, Scottsdale, AZ, 85260, USA, Tel +1-480-614-6001, Fax +1-480-614-6021, Email
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Ichinose K, Tateyama-Makino R, Miyajima A, Morishita S, Iwamoto T, Yamamoto Y. Decreased Frequency of Mental Workload-Induced Subjective Hot Flashes Through Gum Massage: An Open-Label, Self-Controlled Crossover Trial. WOMEN'S HEALTH REPORTS 2022; 3:335-343. [PMID: 35415716 PMCID: PMC8994437 DOI: 10.1089/whr.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
Objective: Hot flashes, a symptom of menopause, can decrease women's quality of life. Sympathetic nervous system activation has been identified as an important factor in the occurrence of hot flashes. Given that somatosensory stimulation of the oral cavity can affect autonomic nervous activity, we aimed to investigate the possibility that somatosensory stimulation of the gums (i.e., gum massage) could improve hot flashes. Materials and Methods: Nineteen women experiencing at least one hot flash per day were instructed to perform a gum massage on themselves before undertaking mental workload, using arithmetic task, and the frequency of hot flashes experienced during this task was measured. Changes in autonomic nervous activity were assessed based on heart rate variability. Results: Massage conditions promoted a significantly lower arithmetic task-induced hot flash frequency compared with nonmassage conditions (p < 0.05). During gum massage, the ratio between low and high frequency (LF/HF) values decreased significantly under massage conditions compared with nonmassage conditions (p < 0.01). During the arithmetic task, the gum massage-induced reduction in LF/HF, which changed from baseline, was significantly correlated with the gum massage-induced reduction in hot flash frequency. Conclusions: The results of this study indicate that gum massage can reduce the subjective frequency of hot flashes over a certain period under mental workload. Our study also indicates that gum massage can potentially decrease sympathetic nerve activity, which is known to be involved in the occurrence of hot flashes. Clinical Trial Registration number 328 (the institutional review board of Lion Corporation).
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Affiliation(s)
- Kanako Ichinose
- Research & Development Headquarters, Lion Corporation, Edogawa-ku, Tokyo, Japan
| | | | - Asami Miyajima
- Research & Development Headquarters, Lion Corporation, Edogawa-ku, Tokyo, Japan
| | - Satoru Morishita
- Research & Development Headquarters, Lion Corporation, Edogawa-ku, Tokyo, Japan
| | - Taku Iwamoto
- Research & Development Headquarters, Lion Corporation, Edogawa-ku, Tokyo, Japan
| | - Yukio Yamamoto
- Research & Development Headquarters, Lion Corporation, Edogawa-ku, Tokyo, Japan
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Ganesh A, Qadri YJ, Boortz-Marx RL, Al-Khatib SM, Harpole DH, Katz JN, Koontz JI, Mathew JP, Ray ND, Sun AY, Tong BC, Ulloa L, Piccini JP, Fudim M. Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias. Curr Hypertens Rep 2020; 22:100. [PMID: 33097982 DOI: 10.1007/s11906-020-01111-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To highlight the indications, procedural considerations, and data supporting the use of stellate ganglion blockade (SGB) for management of refractory ventricular arrhythmias. RECENT FINDINGS In patients with refractory ventricular arrhythmias, unilateral or bilateral SGB can reduce arrhythmia burden and defibrillation events for 24-72 h, allowing time for use of other therapies like catheter ablation, surgical sympathectomy, or heart transplantation. The efficacy of SGB appears to be consistent despite the type (monomorphic vs polymorphic) or etiology (ischemic vs non-ischemic cardiomyopathy) of the ventricular arrhythmia. Ultrasound-guided SGB is safe with low risk for complications, even when performed on anticoagulation. SGB is effective and safe and could be considered for patients with refractory ventricular arrhythmias.
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Affiliation(s)
- Arun Ganesh
- Duke Anesthesiology, Duke University, Durham, NC, USA
| | - Yawar J Qadri
- Emory Anesthesiology, Emory University, Atlanta, GA, USA
| | | | - Sana M Al-Khatib
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - David H Harpole
- Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jason N Katz
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Jason I Koontz
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.,Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke University, Durham, NC, USA
| | | | - Neil D Ray
- Duke Anesthesiology, Duke University, Durham, NC, USA
| | - Albert Y Sun
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Betty C Tong
- Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Luis Ulloa
- Duke Anesthesiology, Duke University, Durham, NC, USA.,Center for Perioperative Organ Protection, Department of Anesthesiology, Duke University, Durham, NC, USA
| | - Jonathan P Piccini
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Marat Fudim
- Duke Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
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Maki PM, Thurston RC. Menopause and Brain Health: Hormonal Changes Are Only Part of the Story. Front Neurol 2020; 11:562275. [PMID: 33071945 PMCID: PMC7538803 DOI: 10.3389/fneur.2020.562275] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/17/2020] [Indexed: 01/12/2023] Open
Abstract
Most studies of menopause and brain aging have focused on the role of the sex steroid hormone, estradiol, as a key mechanisms contributing to cognitive and brain aging in women. An emerging literature demonstrates that beyond endogenous estradiol levels, menopausal symptoms, particularly vasomotor symptoms (VMS), are also key determinants of menopause-related changes in cognition and brain function. Critically, that literature shows the importance of using objective techniques to identify associations of VMS with memory performance, brain structure, and brain function. While self-report measures are important patient-centered outcomes in women's health research, objective measures of VMS typically relate more strongly to indices of cognitive and brain health. Currently, it is premature to make a causal claim about VMS and memory dysfunction, but initial findings raise the possibility that women with VMS might experience an improvement in cognition with VMS treatment. More generally, these findings underscore the utility of investigating female-specific risk factors for cognitive decline.
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Affiliation(s)
- Pauline M Maki
- Women's Mental Health Research Program, Department of Psychiatry, Psychology and Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, United States
| | - Rebecca C Thurston
- Women's Biobehavioral Health Laboratory, Department of Psychiatry, Epidemiology, and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
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Rahimzadeh P, Imani F, Nafissi N, Ebrahimi B, Faiz SHR. Comparison of the effects of stellate ganglion block and paroxetine on hot flashes and sleep disturbance in breast cancer survivors. Cancer Manag Res 2018; 10:4831-4837. [PMID: 30464591 PMCID: PMC6208490 DOI: 10.2147/cmar.s173511] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of menopausal symptoms, including hot flashes and sleep disturbance, caused by drug treatment is a common problem in breast cancer survivors. Considering the limitations of hormone therapy in such patients, several studies have been conducted to find alternative methods. The aim of this study was to investigate and compare the effectiveness of stellate ganglion block (SGB) with that of paroxetine, which was approved by the US Food and Drug Administration (FDA) as a medicine for the treatment of hot flashes and ensuing sleep disturbance. Patients and methods A total of 40 patients survived from breast cancer and complaining of these symptoms were equally assigned to two groups of 20 each. In the study group, SGB was performed successfully under sonography guidance using 10 mL of 0.5% bupivacaine, and in the control group (paroxetine), the daily administration of 7.5 mg of paroxetine was conducted for 6 weeks. The frequency and severity of hot flash attacks and sleep quality of patients were evaluated prior to the intervention and after 2, 4 and 6 weeks. The incidence of adverse events during treatment or follow-up was recorded. Results A significant decrease in hot flash score and sleep disturbance index (SDI) was observed in both groups. Comparison of the results showed no noticeable difference between the two groups. Two participants in the control group had discontinued medication due to gastrointestinal symptoms, and only one case of mild headache was reported in the study group. Conclusion SGB is as much effective as paroxetine in controlling hot flashes and sleep disturbances in breast cancer survivors and is associated with few complications.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran,
| | - Nahid Nafissi
- Department of Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Ebrahimi
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
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Abbasi M, Bambaeichi E, Nematbakhsh M. Co-administration of vitamin C or estradiol with aerobic exercise on liver oxidative stress and enzymes in ovariectomized rat. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-017-0369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Management of hot flashes in women with breast cancer receiving ovarian function suppression. Cancer Treat Rev 2017; 52:82-90. [DOI: 10.1016/j.ctrv.2016.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/25/2016] [Accepted: 11/26/2016] [Indexed: 11/18/2022]
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Faubion SS, Loprinzi CL, Ruddy KJ. Management of Hormone Deprivation Symptoms After Cancer. Mayo Clin Proc 2016; 91:1133-46. [PMID: 27492917 DOI: 10.1016/j.mayocp.2016.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 04/05/2016] [Indexed: 02/08/2023]
Abstract
Cancer survivors often experience symptoms related to hormone deprivation, including vasomotor symptoms, genitourinary symptoms, and sexual health concerns. These symptoms can occur due to natural menopause in midlife women, or they can be brought on by oncologic therapies in younger women or men. We searched PubMed for English-language studies from January 1990 through January 2016 to identify relevant articles on the management of hormone deprivation symptoms, including vasomotor, genitourinary, and sexual symptoms in patients with cancer. The search terms used included hormone deprivation, vasomotor symptoms, hot flash, vaginal dryness, sexual dysfunction, and breast cancer. This manuscript provides a comprehensive description of data supporting the treatment of symptoms associated with hormone deprivation.
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Affiliation(s)
- Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Charles L Loprinzi
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
| | - Kathryn J Ruddy
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
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10
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11
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Othman AH, Zaky AH. Management of Hot Flushes in Breast Cancer Survivors: Comparison Between Stellate Ganglion Block and Pregabalin. PAIN MEDICINE 2014; 15:410-7. [DOI: 10.1111/pme.12331] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Guttuso T. Stellate ganglion block for treating hot flashes: a viable treatment option or sham procedure? Maturitas 2013; 76:221-4. [PMID: 24021996 DOI: 10.1016/j.maturitas.2013.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
Stellate ganglion block (SGB) has been used for over 70 years to treat various cervical pain syndromes. Over the past 8 years, 4 different groups have reported on SGB's effects on hot flashes from unblinded, open-label trials. Review of these studies has shown markedly disparate results in terms of the magnitude of hot flash reduction from Baseline with one trial showing a 90% reduction in hot flashes and 3 other trials showing 28-44% reductions in hot flashes. The inconsistencies in these results in addition to the known potentially large (>50%) placebo effects that can occur in randomized controlled hot flash clinical trials make it difficult to render any conclusions regarding the efficacy of SGB for hot flashes at this time. A randomized controlled trial, including a sham saline treatment arm, needs to be performed to properly assess SGB's effects on hot flashes, Methodological challenges with such a study design are addressed and several suggestions are proposed to manage these challenges.
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Affiliation(s)
- Thomas Guttuso
- University at Buffalo, 3435 Main St., Buffalo, NY 14214, United States.
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Fisher WI, Johnson AK, Elkins GR, Otte JL, Burns DS, Yu M, Carpenter JS. Risk factors, pathophysiology, and treatment of hot flashes in cancer. CA Cancer J Clin 2013; 63:167-92. [PMID: 23355109 PMCID: PMC3640615 DOI: 10.3322/caac.21171] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hot flashes are prevalent and severe symptoms that can interfere with mood, sleep, and quality of life for women and men with cancer. The purpose of this article is to review existing literature on the risk factors, pathophysiology, and treatment of hot flashes in individuals with cancer. Electronic searches were conducted to identify relevant English-language literature published through June 15, 2012. Results indicated that risk factors for hot flashes in cancer include patient-related factors (eg, age, race/ethnicity, educational level, smoking history, cardiovascular risk including body mass index, and genetics) and disease-related factors (eg, cancer diagnosis and dose/type of treatment). In addition, although the pathophysiology of hot flashes has remained elusive, these symptoms are likely attributable to disruptions in thermoregulation and neurochemicals. Therapies that have been offered or tested fall into 4 broad categories: pharmacological, nutraceutical, surgical, and complementary/behavioral strategies. The evidence base for this broad range of therapies varies, with some treatments not yet having been fully tested or showing equivocal results. The evidence base surrounding all therapies is evaluated to enhance hot flash treatment decision-making by clinicians and patients.
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Affiliation(s)
- William I Fisher
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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Hickey AH, Navaie M, Stedje-Larsen ET, Lipov EG, McLay RN. Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20130205-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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van Gastel P, Kallewaard JW, van der Zanden M, de Boer H. Stellate-ganglion block as a treatment for severe postmenopausal flushing. Climacteric 2012; 16:41-7. [PMID: 23017097 DOI: 10.3109/13697137.2012.709889] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Hormone replacement therapy is the most effective treatment for postmenopausal flushing. Unfortunately, its use is often contraindicated. A limited amount of uncontrolled data suggests that stellate-ganglion block (SGB) may be useful for the treatment of hot flushes. In the present study, we examined whether previously reported results could be reproduced in women with severe postmenopausal flushing. METHODS Twenty postmenopausal women with a baseline hot flush score ≥ 15 were treated with SGB in an open, uncontrolled setting. This mean daily hot flush score was calculated as the product of flush frequency and flush severity over a period of 1 week. The response to treatment was evaluated by flush scores and assessment of quality of life at baseline and 4 weeks after SGB. RESULTS The per-protocol analysis included 19 women. One woman was excluded because of lack of Horner syndrome after SGB. Four weeks after SGB, the mean flush score had decreased by 34 ± 7.4% (95% confidence interval (CI) 18-49%; p < 0.005). Nine women had a decrease in flush score between 40 and 90%, with a mean response of 65 ± 4.9% (95% CI 53-76%). The other ten women were non-responders with a decrease in flush score between 0 and 11%. Quality of life and sleep, both assessed by questionnaire, improved significantly. CONCLUSIONS The results of this study support the observation that SGB may be a useful therapy for a subset of women with severe postmenopausal flushing. A sham-controlled, single-blinded study is warranted to improve the evidence of efficacy.
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Affiliation(s)
- P van Gastel
- Department of Internal Medicine Gynecology, Rijnstate Hospital, Arnhem, The Netherlands
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Jones JM, Kohli M, Loprinzi CL. Androgen deprivation therapy-associated vasomotor symptoms. Asian J Androl 2012; 14:193-7. [PMID: 22286861 PMCID: PMC3338189 DOI: 10.1038/aja.2011.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 10/10/2011] [Accepted: 11/29/2011] [Indexed: 12/21/2022] Open
Abstract
Androgen deprivation therapy (ADT) is widely used as standard therapy in the treatment of locally advanced and metastatic prostate cancer. While efficacious, ADT is associated with multiple side effects, including decreased libido, erectile dysfunction, diabetes, loss of muscle tone and altered body composition, osteoporosis, lipid changes, memory loss, gynecomastia and hot flashes. The breadth of literature for the treatment of hot flashes is much smaller in men than that in women. While hormonal therapy of hot flashes has been shown to be effective, multiple non-hormonal medications and treatment methods have also been developed. This article reviews current options for the treatment of hot flashes in patients taking ADT.
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Affiliation(s)
- Jason M Jones
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
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Haest K, Kumar A, Van Calster B, Leunen K, Smeets A, Amant F, Berteloot P, Wildiers H, Paridaens R, Van Limbergen E, Weltens C, Janssen H, Peeters S, Menten J, Vergote I, Morlion B, Verhaeghe J, Christiaens MR, Neven P. Stellate ganglion block for the management of hot flashes and sleep disturbances in breast cancer survivors: an uncontrolled experimental study with 24 weeks of follow-up. Ann Oncol 2011; 23:1449-54. [PMID: 22039079 DOI: 10.1093/annonc/mdr478] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. Following an initial pilot study, which focused on the acceptability and safety of SGB for this important problem, we evaluated its short- and long-term efficacy. MATERIALS AND METHODS Postmenopausal breast cancer survivors with severe vasomotor symptoms resistant to standard nonhormonal pharmacological intervention were eligible. Diaries were used to measure daily hot flash scores (frequency and intensity) and sleep quality (Pittsburgh Sleep Quality Index) during scheduled visits at baseline, 1, 4, 12 and 24 weeks following the SGB. Efficacy data were analyzed using longitudinal regression models. RESULTS Thirty-four patients participated and none refused the SGB procedure. Most patients received more than one SGB. The pilot study found SGB to be safe. In the main study, hot flash scores were reduced from baseline by 64% [95% confidence interval (CI) -74% to -49%] and 47% (95% CI -62% to -27%) at weeks 1 and 24, respectively. The odds ratio of better sleep quality relative to baseline was 3.4 at week 1 (95% CI 1.6-7.2) and 4.3 at week 24 (95% CI 1.9-9.8). CONCLUSION In the short term, SGB appears to be an effective treatment with acceptable morbidity for some breast cancer survivors with therapy-resistant vasomotor symptoms and/or sleep disturbances. Although sleep quality was maintained out to 24 weeks the efficacy of SGB for hot flashes was reduced over time. A randomized controlled trial is needed to confirm these findings.
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Affiliation(s)
- K Haest
- Department of Obstetrics and Gynecology, University Hospitals Leuven and Katholieke Universiteit Leuven, Belgium
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Pachman DR, Barton D, Carns PE, Novotny PJ, Wolf S, Linquist B, Kohli S, Smith DR, Loprinzi CL. Pilot evaluation of a stellate ganglion block for the treatment of hot flashes. Support Care Cancer 2011; 19:941-7. [PMID: 20496155 PMCID: PMC3107341 DOI: 10.1007/s00520-010-0907-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/05/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Hot flashes are a significant problem in breast cancer patients, especially because the most effective therapy, estrogen, is often contraindicated. Based on recent pilot data from a single group supporting the use of a stellate ganglion block for the treatment of hot flashes, the present pilot trial was done to further evaluate the hypothesis that a stellate ganglion block may be a safe and effective therapy for hot flashes. METHODS In women with breast cancer who had hot flashes, a stellate ganglion block was performed after 1 week of baseline hot flash data collection. The main efficacy measures were the changes from baseline in hot flash frequency and hot flash score during the 6th week. RESULTS Ten patients were enrolled between 4/23/2009 and 7/10/2009; eight patients were evaluable. After the stellate ganglion block, the mean hot flash frequency and score decreased from baseline values by over 60% during some of the post-treatment weeks. The mean hot flash frequency and score at week 6 decreased from baseline values by 44% and 45%, respectively. There were no significant adverse events clearly attributed to the stellate ganglion blocks. CONCLUSIONS The results of this pilot trial support that stellate ganglion blocks may be a helpful therapy for hot flashes. A prospective placebo-controlled clinical trial should be done to more definitively determine this contention.
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Affiliation(s)
- Deirdre R Pachman
- Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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20
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Lipov E, Kelzenberg BM. Stellate ganglion block (SGB) to treat perimenopausal hot flashes: clinical evidence and neurobiology. Maturitas 2011; 69:95-6. [PMID: 21377301 DOI: 10.1016/j.maturitas.2011.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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Pachman DR, Jones JM, Loprinzi CL. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions. Int J Womens Health 2010; 2:123-35. [PMID: 21072305 PMCID: PMC2971731 DOI: 10.2147/ijwh.s7721] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 12/21/2022] Open
Abstract
Hot flashes are one of the most common and distressing symptoms associated with menopause, occurring in more than 75% of postmenopausal women. They are especially problematic in breast cancer patients since some breast cancer therapies can induce hot flashes. For mild hot flashes, it is proposed that behavioral modifications are the first step in management. Hormonal therapies, including estrogens and progestogens, are the most well known effective agents in relieving hot flashes; however, the safety of these agents is controversial. There is an increasing amount of literature on nonhormonal agents for the treatment of hot flashes. The most promising data regard newer antidepressant agents such as venlafaxine, which reduces hot flashes by about 60%. Gabapentin is another nonhormonal agent that is effective in reducing hot flashes. While many complimentary therapies, including phytoestrogens, black cohosh, and dehydroepiandrosterone, have been explored for the treatment of hot flashes; none can be recommended at this time. Furthermore, there is a lack of strong evidence to support exercise, yoga, or relaxation for the treatment of hot flashes. Paced respirations and hypnosis appear to be promising enough to warrant further investigation. Another promising nonpharmacological therapy, currently under investigation, involves a stellate ganglion block.
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Chan CW, Chalkiadis GA. A Case of Sympathetically Mediated Headache Treated with Stellate Ganglion Blockade. PAIN MEDICINE 2010; 11:1294-8. [DOI: 10.1111/j.1526-4637.2010.00850.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kontos M, Agbaje OF, Rymer J, Fentiman IS. What can be done about hot flushes after treatment for breast cancer? Climacteric 2010; 13:4-21. [DOI: 10.3109/13697130903291058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lipov EG, Joshi JR, Sanders S, Slavin KV. A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Med Hypotheses 2009; 72:657-61. [PMID: 19237252 DOI: 10.1016/j.mehy.2009.01.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 01/08/2009] [Accepted: 01/12/2009] [Indexed: 11/19/2022]
Abstract
The mechanism of action of the stellate ganglion block (SGB) is still uncertain; however it has been used successfully in treatment of chronic regional pain syndrome (CRPS) for many years. Our new insights in to the mechanism of action of the stellate ganglion block were first reported in 2007 in our publication detailing the control of hot flashes with the use of stellate ganglion blockade. We have demonstrated very significant results in the treatment of hot flashes and our most recent application of this block has been for the treatment of posttraumatic stress disorder (PTSD). Stellate ganglion has been demonstrated to have second and third order neurons connections with the central nervous system nuclei that modulate body temperature, neuropathic pain, the manifestations of PTSD, and many other areas. We believe that the commonality between the CRPS, HF and PTSD is the trigger of increased nerve growth factor (NGF) leading to the increase in brain norepinephrine (NR), which in turn is affected by the SGB leading to a prolonged reduction of NGF and eventually a decrease in NR. This, in turn, leads to a reduction or elimination of many of the symptoms of CRPS, Hot flashes, and PTSD.
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Affiliation(s)
- Eugene G Lipov
- Advanced Pain Centers S.C., 2260 W. Higgins Rd., Ste. 101, Hoffman Estates, IL 60169, USA.
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Updated findings on the effects of stellate-ganglion block on hot flushes and night awakenings. Lancet Oncol 2008; 9:819-20. [DOI: 10.1016/s1470-2045(08)70218-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, Maganini R, Slavin K. Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol 2008; 9:523-32. [PMID: 18485819 DOI: 10.1016/s1470-2045(08)70131-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lipov EG, Lipov S, Joshi JR, Santucci VD, Slavin KV, Beck Vigue SG. Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system. Med Hypotheses 2007; 69:758-63. [PMID: 17425958 DOI: 10.1016/j.mehy.2007.01.082] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 01/27/2007] [Indexed: 11/30/2022]
Abstract
Stellate ganglion block is routinely used in pain clinics. The mechanism of action of the stellate ganglion block is uncertain; the most common explanation is that it produces peripheral vasodilation, resulting in neural inhibition in the ganglion's sphere of innervation. However, the wide range of conditions that have been reported to respond favorably to stellate ganglion block suggest that its effectiveness may not be solely the result of increased blood flow nor restricted just to its sphere of innervation. We have found that stellate ganglion block is effective in the treatment of hot flashes in postmenopausal women, as well as those with estrogen depletion resulting from breast cancer treatment. Based on evidence that hot flashes may be centrally mediated and that the stellate ganglion has links with the central nervous system nuclei that modulate body temperature, we hypothesize that the stellate ganglion block provides relief of hot flashes by interrupting the central nervous system connections with the sympathetic nervous system, allowing the body's temperature-regulating mechanisms to reset. If this mechanism can be confirmed, this would provide women with intractable hot flashes with an effective, potentially long-lasting means of relieving their symptoms, and potentially widen the range of indications for stellate ganglion block to include other centrally mediated syndromes.
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Affiliation(s)
- E G Lipov
- Alexian Brothers Hospital Network Pain Program, Hoffman Estates, IL, USA.
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