Stellate ganglion "blocks" with morphine in sympathetic type pain

Mays, Kit S.; North, William C.; Schnapp, Moacir

doi:10.1136/jnnp.44.2.189

Cited by 28 publications

(12 citation statements)

References 3 publications

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“…In addition, Mays et al [36] performed stellate nerve block using local opioid injections in patients with chronic headache and reported the effectiveness of this treatment. Maier et al [37], suggested that blockade of the superior cervical ganglion would be effective in different types of painful conditions of the head and face [30].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Local Lidocaine Application on Anxiety and Depression and Its Curative Effect on Patients with Chronic Tension-Type Headache

et al. 2013

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Background: Tension-type headache (TTH) is a primary headache disorder. In this study, the efficacy of local lidocaine application on anxiety and depression and its curative effect in patients with chronic TTH was investigated. Methods: Forty-eight patients (24 local lidocaine injection, 24 local saline injection group) with chronic TTH were enrolled in our study. Injections were applied to the trigger points of the muscles that are innervated by C1-C3 and the trigeminal nerve, exit points of the fifth cranial nerve, and around the superior cervical ganglion. Each patient underwent one session every 3 days. Patients were evaluated before and 3 months after the treatment. Results: In both groups, the number of painful days in a month, visual analogue scale values, amount of analgesic use in a month, Hamilton depression score, and Hamilton anxiety score decreased after the treatment. As a result, all of the parameters were found to have improved in both groups (p < 0.05), the results were statistically significant, and the lidocaine group's response to the treatment was better than the placebo group (p < 0.001). Conclusion: Our findings suggest that local lidocaine administration can be an effective method in the treatment of chronic TTH.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Local Lidocaine Application on Anxiety and Depression and Its Curative Effect on Patients with Chronic Tension-Type Headache

et al. 2013

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“…Zum gleichen Schluß kamen Mays et al, die Erstbeschreiber der GLOA-Therapie: "Eight of ten patients obtained substantial … relief with both the local anaesthetic and morphine, but they all stated that morphine provides more profound pain relief as well as fewer side effects" [78].…”

Section: Grenzstrangblockade Und Intravenöse Regionale Sympathikolysementioning

confidence: 99%

“…Die Analgesie nach GLOA beruht offensichtlich nicht auf einem systemischen Opioideffekt [38,69,78]. In einer weiteren Studie, die der placebokontrollierten Prüfung der initialen Wirksamkeit diente, wurde in einem Crossover-Vergleich der Effekt von Kochsalzmit dem von Buprenorphin bei Injektionen am zervikalen Grenzstrang bei 14 Patienten mit einer Zosterneuralgie verglichen.…”

Section: Autonome Störungenunclassified

Diagnostik und Therapie des sympathisch unterhaltenen Schmerzes

Maier

Gleim

1998

Der Schmerz

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The term "sympathetically maintained pain" (SMP) describes a symptom that might accompany a variety of diseases (CRPS, (post-) herpetic and post-injury neuralgia), which might transform into sympathetically independent pain (SIP) after some time. Patients with SMP present a bunch of disorders of the autonomic and sensory system, but the only reliable way to diagnose a pain as SMP is a positive response to an intervention at the sympathetic nervous system. Three ways of influencing the sympathetic system are commonly used: (a) local anesthetic sympathetic blockade (SB), (b) intravenous regional sympathectomy (IVRS) and (c) ganglionic local opioid application (GLOA). A review of current literature shows that SB has certain advantages in diagnostic sensitivity, whereas GLOA might be slightly superior in therapy of some diseases with longstanding pain history. Obviously, the therapeutic benefit of all interventions is complete independent of the accompanying autonomic disorder and of a blockade of efferent fibers. A new heuristic model of the SMP mechanism is presented, including both experimental and clinical data. For reducing the risks of false positive or negative diagnosis of SMP and SIP, a diagnostic algorithm is proposed. This includes optimizing the technique, changes of interventional measures, and adequate monitoring both of analgesia and as well of the extend of efferent sympathetic blockade (e.g. measurement of sympathetic reflexes). The treatment recommendations in patients with SMP vary in dependence of the kind of disease. In SMP, invasive measures play an important, but only limited role within the comprehensive treatment concept. As an example a three-stage, symptom-adapted treatment algorithm is demonstrated for CRPS, including also drug therapy, psychologic and physiotherapeutic approaches.

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“…1,2 In 1981, Mays described administering morphine at the stellate ganglion for upper extremity sympathetic pain. 1 Wassef 3 reported the use of the ipsilateral stellate-ganglion infiltration with fentanyl in a patient who suffered from phantom-limb pain and probable complex regional pain syndrome (CRPS). Arias et al 4 have also shown stellate-ganglion injection with sufentanil to be helpful in 2 patients with refractory CRPS of the upper extremity.…”

Section: Discussionmentioning

confidence: 99%