Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system

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Summary

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.

Section snippets

Hypothesis

The stellate ganglion is sympathetic ganglion located anterior to and below the transverse process of C6 and C7 and ventral or ventromedial to the vertebral artery. Through direct innervation it has effects on the head, neck, heart, and upper extremities. Stellate ganglion block is a selective sympathetic block that influences ipsilateral head, neck, upper extremity, and the upper part of the thorax. The stellate ganglion block is frequently used in pain clinics for the treatment of migraines,

Evidence of central sympathetic involvement in hot flashes

The symptoms of hot flashes that occur in menopausal women are characteristic of a heat-dissipation response and consist of sudden sensations of intense heat with sweating, flushing, and peripheral vasodilation. The exact pathogenesis of hot flashes has not been entirely elucidated, but there appears to be an alteration in the homeostatic thermoregulatory system. The underlying physiological systems implicated in the etiology of hot flashes include the sympathetic nervous system and the

Evidence that part of the effect of stellate ganglion block is centrally mediated

Other than hot flashes, there are other conditions known to respond favorably to stellate ganglion block that are thought to be centrally mediated. One such condition is complex regional pain syndrome (CRPS; also called reflex sympathetic dystrophy) [23]. In a review of CRPS, Bogduk reports that although some view the condition as psychoneurogenic, “most recent work favors a central mechanism” for both the sensory and autonomic features of the syndrome [24]. Shiraishi et al. conducted a study

Conclusion

Based on the evidence summarized above, that hot flashes may be centrally mediated and due to an increased activity of central nervous system nuclei linked to the sympathetic nervous system and norepinephrine release, the hypothesis that the stellate ganglion block works to relieve hot flashes by interrupting the sympathetic nervous system seems to be a likely possibility. Further support is derived from other reports that stellate ganglion block is effective for other conditions known to be

Acknowledgements

The authors thank Amy Akers for help in preparation of the manuscript and text editing, and Christa Wellman, M.A.M.S., for the creation of the illustrations.

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