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)
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.
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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 :Stellate ganglion blockade (SGB) is a selective block of the cervical sympathetic chain designed to reduce autonomic reactivity. 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.