Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system
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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2018, The Breast: Comprehensive Management of Benign and Malignant DiseasesStellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial
2016, MaturitasCitation Excerpt :Cortisol has been linked to decreases in memory, particularly in women [37,38]. Alternatively, SGB may alter the sympathetic nervous system or brain derived neurotrophic factor [39,40]. The duration of VMS effect in the parent trial lasted six months, far beyond the duration of sympatholysis and bupivacaine half-life.
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2016, Mayo Clinic ProceedingsCitation Excerpt :It has been used with mixed results to treat complex pain syndromes,64-67 and there are preliminary data suggesting that SGB may help treat posttraumatic stress disorder.68 Lipov et al67,69 proposed that SGB might be helpful for alleviating hot flashes after experiments showed that injection of a modified rabies virus in the stellate ganglion of an animal led to viral spread to areas of the brain thought to be related to temperature regulation: the amygdala, insulate, and hypothalamus. He reported positive-appearing, nonrandomized pilot trials including 2 groups of women with70 and without71 a history of breast cancer; similar results were seen in pilot trials from other institutions.72-74
Stellate ganglion block may prevent the development of neurogenic pulmonary edema and improve the outcome
2013, Medical HypothesesCitation Excerpt :Stellate ganglion block (SGB) produces a complete sympathetic denervation by temporarily blocking the sympathetic out flow to the head, neck and the upper extremity, and induces peripheral vasodilatation [3]. SGB has a much wider range of indications, such as vascular headache, chronic regional pain syndrome [4], pulmonary embolism [5], cardiac arrhythmias [6], hot flashes [7] and post-traumatic stress disorder (PTSD) [8]. SGB has also been recommended for relieving cerebral vasospasm and improving the blood flow following a cerebrovascular accident [9].
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2012, Trends in Anaesthesia and Critical CareCitation Excerpt :Stellate ganglion blocks are performed thousands of times every year, even though clear evidence of its long-term therapeutic use in chronic pain patients remains sparse. It is usually performed in patients with ischemic or sympathetically maintained pain states of the head or the upper extremity19 and its use might actually increase in future, since several studies have reported a potential benefit in certain non-pain-indications, such as treatment of anxiety and panic symptoms20 or relief of hot flushes in postmenopausal women, as well as those with estrogen depletion resulting from breast cancer treatment.21,22 Several puncture techniques have been described in the medical literature.