Elsevier

Medical Hypotheses

Volume 72, Issue 6, June 2009, Pages 657-661
Medical Hypotheses

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)

https://doi.org/10.1016/j.mehy.2009.01.009Get rights and content

Summary

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.

Section snippets

Hypothesis

Stellate ganglion block (SGB) is a selective sympathetic block that influences ipsilateral head, neck, upper extremity, and the upper part of the thorax by temporarily blocking the sympathetic out flow to those regions. It has been used for at least 60 years as a treatment of migraines, atypical facial pain, upper extremity pain, and complex regional pain syndrome. In Japan, the stellate ganglion block has a much wider range of indications and is used for many systemic diseases including

Conclusion

Based on the evidence summarized, we believe that CRPS, hot flashes and PTSD are centrally mediated, where a relevant insult leads to increase in NGF levels which starts a cascade that leads to sympathetic sprouting, which further increases brain norepinephrine, which finally leads to the clinical conditions in described in this article. Reversal of this cascade occurs by application of the local anesthetic to the stellate ganglion, which reduces NGF, which reduces sympathetic sprouting,

Acknowledgements

We would like to thank Curt Rabinak, illustrator for Figs. 2–4 and Paul Deane, librarian at Alexian Brothers Medical Center.

References (32)

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