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Pilot evaluation of a stellate ganglion block for the treatment of hot flashes

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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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References

  1. Barton D, LaVasseur B, Sloan JA et al (2008) A Phase III trial evaluating three doses of citalopram for hot flashes: NCCTG Trial N05C9. J Clin Oncol (26 Suppl): Abstract 9538

  2. Breivik H, Cousins M, Lofstrom JB (1998) Sympathetic neural blockade of upper and lower extremity. In: Cousins MJ, Bridenbaugh PO (eds) Neural bloackade in clinical anesthesia and management of pain, 3rd edn. Lippincott-Raven, Philadelphia, pp 411–447

    Google Scholar 

  3. Carpenter J, Johnson D, Wagner L, Andrykowski M (2002) Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncol Nurs Forum 29:E16–E25

    Article  PubMed  Google Scholar 

  4. Carpenter JS, Andrykowski MA (1999) Menopausal symptoms in breast cancer survivors. Oncol Nurs Forum 26:1311–1317

    PubMed  CAS  Google Scholar 

  5. Couzi R, Helzlsouer K, Fetting J (1995) Prevelance of menopausal symptoms amoung women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 13:2737–2744

    PubMed  CAS  Google Scholar 

  6. Egawa H, Okuda Y, Kitajima T, Minami J (2001) Assessment of QT interval and QT dispersion following stellate ganglion block using computerized measurements. Reg Anesth Pain Med 26:539–544

    PubMed  CAS  Google Scholar 

  7. Elias M (2000) Cervical sympathetic and stellate ganglion blocks. Pain Physician 3:294–304

    PubMed  CAS  Google Scholar 

  8. Finck G, Barton D, Loprinzi C et al (1998) Definitions of hot flashes in breast cancer survivors. J Pain Symptom Manage 16:327–333

    Article  PubMed  CAS  Google Scholar 

  9. Forouzanfar T, van Kleef M, Weber WE (2000) Radiofrequency lesions of the stellate ganglion in chronic pain syndromes: retrospective analysis of clinical efficacy in 86 patients. Clin J Pain 16:164–168

    Article  PubMed  CAS  Google Scholar 

  10. Freedman RR (2001) Physiology of hot flashes. Am J Hum Biol 13:453–464

    Article  PubMed  CAS  Google Scholar 

  11. Freedman RR, Benton MD, Genik RJ 2nd, Graydon FX (2006) Cortical activation during menopausal hot flashes. Fertil Steril 85:674–678

    Article  PubMed  Google Scholar 

  12. Goldberg RM, Loprinzi CL, O'Fallon JR, Veeder MH, Miser AW, Mailliard JA, Michalak JC, Dose AM, Rowland KM Jr, Burnham NL (1994) Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. J Clin Oncol 12:155–158

    PubMed  CAS  Google Scholar 

  13. Guttuso TJ Jr (2000) Gabapentin's effects on hot flashes and hypothermia. Neurology 54:2161–2163

    PubMed  Google Scholar 

  14. Haest K, Kumar A, Leunen K, Smeets A, Amant F, Berteloot et al (2009) Does the stellate ganglion block reduce severe hot flushes and sleep disturbances in breast cancer patients? Cancer Res 69(24 Suppl): Abstract nr 809

  15. Kapa S, Tester DJ, Salisbury BA, Harris-Kerr C, Pungliya MS, Alders M, Wilde AA, Ackerman MJ (2009) Genetic testing for long-QT syndrome: distinguishing pathogenic mutations from benign variants. Circulation 120:1752–1760

    Article  PubMed  CAS  Google Scholar 

  16. Lipov E, Lipov S, Stark JT (2005) Stellate ganglion blockade provides relief from menopausal hot flashes: a case report series. J Womens Health 14:737–741

    Article  Google Scholar 

  17. Lipov EG, Joshi JR, Sanders S (2009) A new mechanism of action for tamoxifen. Lancet Oncol 10:542

    Article  PubMed  Google Scholar 

  18. Lipov EG, Joshi JR, Sanders S, Slavin KV (2009) 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 72:657–661

    Article  PubMed  Google Scholar 

  19. Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, Maganini R, Slavin K (2008) Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol 9:523–532

    Article  PubMed  Google Scholar 

  20. Lipov EG, Joshi JR, Xie H, Slavin KV (2008) Updated findings on the effects of stellate-ganglion block on hot flushes and night awakenings. Lancet Oncol 9:819–820

    Article  PubMed  Google Scholar 

  21. Lipov EG, Lipov S, Joshi JR, Santucci VD, Slavin KV, Beck Vigue SG (2007) Stellate ganglion block may relieve hot flashes by interrupting the sympathetic nervous system. Med Hypotheses 69:758–763

    Article  PubMed  CAS  Google Scholar 

  22. Loprinzi C, Barton D, Rhodes D (2001) Management of hot flashes in breast-cancer survivors. Lancet Oncol 2:199–204

    Article  PubMed  CAS  Google Scholar 

  23. Loprinzi C, Zahasky K, Sloan J, Novotny P, Quella S (2000) Tamoxifen-induced hot flashes. Clin Breast Cancer 1:52–56

    Article  PubMed  CAS  Google Scholar 

  24. Loprinzi CL, Barton DL, Carns PE (2008) Stellate-ganglion block: a new treatment for hot flushes? Lancet Oncol 9:506–507

    Article  PubMed  Google Scholar 

  25. Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, Novotny PJ, Dakhil SR, Rodger K, Rummans TA, Christensen BJ (2000) Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 356:2059–2063

    Article  PubMed  CAS  Google Scholar 

  26. Loprinzi CL, Michalak JC, Quella SK, O'Fallon JR, Hatfield AK, Nelimark RA, Dose AM, Fischer T, Johnson C, Klatt NE et al (1994) Megestrol acetate for the prevention of hot flashes. N Engl J Med 331:347–352

    Article  PubMed  CAS  Google Scholar 

  27. Loprinzi CL, Qin R, Balcueva EP, Flynn KA, Rowland KM Jr, Graham DL, Erwin NK, Dakhil SR, Jurgens DJ, Burger KN (2010) Phase III, randomized, double-blind, placebo-controlled evaluation of pregabalin for alleviating hot flashes, N07C1. J Clin Oncol 28:641–647

    Article  PubMed  CAS  Google Scholar 

  28. Loprinzi CL, Sloan J, Stearns V, Slack R, Iyengar M, Diekmann B, Kimmick G, Lovato J, Gordon P, Pandya K, Guttuso T Jr, Barton D, Novotny P (2009) Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis. J Clin Oncol 27:2831–2837

    Article  PubMed  CAS  Google Scholar 

  29. Loprinzi CL, Sloan JA, Perez EA, Quella SK, Stella PJ, Mailliard JA, Halyard MY, Pruthi S, Novotny PJ, Rummans TA (2002) Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 20:1578–1583

    Article  PubMed  CAS  Google Scholar 

  30. Notelovitz M, Lenihan JP, McDermott M, Kerber IJ, Nanavati N, Arce J (2000) Initial 17beta-estradiol dose for treating vasomotor symptoms. Obstet Gynecol 95:726–731

    Article  PubMed  CAS  Google Scholar 

  31. Pandya KJ, Morrow GR, Roscoe JA, Zhao H, Hickok JT, Pajon E, Sweeney TJ, Banerjee TK, Flynn PJ (2005) Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet 366:818–824

    Article  PubMed  CAS  Google Scholar 

  32. Pandya KJ, Raubertas RF, Flynn PJ, Hynes HE, Rosenbluth RJ, Kirshner JJ, Pierce HI, Dragalin V, Morrow GR (2000) Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study. Ann Intern Med 132:788–793

    PubMed  CAS  Google Scholar 

  33. Santen R, Pritchard K, Burger H (1998) The consensus conference on treatment of estrogen deficiency symptoms in women surviving breast cancer. Obstet Gynecol Surv 53:S1–S83

    Article  PubMed  CAS  Google Scholar 

  34. Saxena AK, Aggarwal B, Nakra D, Sethi AK, Aggarwal AN (2004) Evaluation of PR, RR, QT intervals and QT dispersion following stellate ganglion block in chronic shoulder–hand pain patients. Pain Pract 4:91–97

    Article  PubMed  Google Scholar 

  35. Sloan JA, Loprinzi CL, Novotny PJ, Barton DL, Lavasseur BI, Windschitl H (2001) Methodologic lessons learned from hot flash studies. J Clin Oncol 19:4280–4290

    PubMed  CAS  Google Scholar 

  36. Slovacek L, Ansorgova V, Macingova Z, Haman L, Petera J (2008) Tamoxifen-induced QT interval prolongation. J Clin Pharm Ther 33:453–455

    Article  PubMed  CAS  Google Scholar 

  37. Song JG, Hwang GS, Lee EH, Leem JG, Lee C, Park PH, Shin JW (2009) Effects of bilateral stellate ganglion block on autonomic cardiovascular regulation. Circ J 73:1909–1913

    Article  PubMed  Google Scholar 

  38. Speroff L, Gass M, Constantine G, Olivier S (2008) Efficacy and tolerability of desvenlafaxine succinate treatment for menopausal vasomotor symptoms: a randomized controlled trial. Obstet Gynecol 111:77–87

    Article  PubMed  CAS  Google Scholar 

  39. Stearns V, Beebe KL, Iyengar M, Dube E (2003) Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA 289:2827–2834

    Article  PubMed  CAS  Google Scholar 

  40. Stearns V, Slack R, Greep N, Henry-Tilman R, Osborne M, Bunnell C, Ullmer L, Gallagher A, Cullen J, Gehan E, Hayes DF, Isaacs C (2005) Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol 23:6919–6930

    Article  PubMed  CAS  Google Scholar 

  41. Tourney W (1948) Occurrance and management of reflex sympathetic dystropy (causalgia of the extremities). J Bone Jt Surg 30:883–907

    Google Scholar 

  42. van Boxem K, van Eerd M, Brinkhuize T, Patijn J, van Kleef M, van Zundert J (2008) Radiofrequency and pulsed radiofrequency treatment of chronic pain syndromes: the available evidence. Pain Pract 8:385–393

    Article  PubMed  Google Scholar 

  43. Westerhaus MJ, Loewy AD (2001) Central representation of the sympathetic nervous system in the cerebral cortex. Brain Res 903:117–127

    Article  PubMed  CAS  Google Scholar 

  44. Wulf H, Maier C (1992) Complications and side effects of stellate ganglion blockade. Results of a questionnaire survey. Anaesthesist 41:146–151

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Deirdre R. Pachman

  2. Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Debra Barton, Sherry Wolf, Breanna Linquist, Sadhna Kohli, DeAnne R. Smith & Charles L. Loprinzi

  3. Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Paul E. Carns

  4. Statistics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Paul J. Novotny

Authors
  1. Deirdre R. Pachman
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  2. Debra Barton
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  3. Paul E. Carns
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  4. Paul J. Novotny
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  5. Sherry Wolf
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  6. Breanna Linquist
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  7. Sadhna Kohli
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  8. DeAnne R. Smith
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  9. Charles L. Loprinzi
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Corresponding author

Correspondence to Charles L. Loprinzi.

Additional information

Clinical trials registration number: NCT00879164

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Pachman, D.R., Barton, D., Carns, P.E. et al. Pilot evaluation of a stellate ganglion block for the treatment of hot flashes. Support Care Cancer 19, 941–947 (2011). https://doi.org/10.1007/s00520-010-0907-9

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  • DOI: https://doi.org/10.1007/s00520-010-0907-9

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