Stellate ganglion intervention for chronic pain: A review

Abstract

Stellate ganglion (SG) intervention is currently widely being studied in many kinds of chronic pain. As one of the convenient ways to treat the sympathetic nervous system, the indications for stellate ganglion intervention (SGI) include complex regional pain syndrome, postherpetic neuralgia, cancer pain of different origins, orofacial pain, and so forth. SGI refers to the reversible or irreversible blocking of the cervical sympathetic trunk, cervical sympathetic ganglion, and their innervation range through noninvasive or minimally invasive treatment. Current treatment options include stellate ganglion block (SGB), SG pulsed radiofrequency, continuous radiofrequency treatment, and noninvasive SGB. In particular, SGB continues to be one of the most studied methods in chronic pain management. However, a single SGB usually provides only short-term effects; repeated SGB may result in complications such as hoarseness, light-headedness, and vessel or nerve injury. Meanwhile, the mechanism of SGI is still unclear. This review discusses the research progress of SGI methods, effectiveness, complications, and possible mechanisms in the management of chronic pain.chronic pain, pulse radiofrequency, stellate ganglion, stellate ganglion block | INTRODUCTIONChronic pain is defined as pain that persists or recurs for more than 3 months, usually accompanied by negative emotions including anxiety and/or depression. 1 Chronic pain severely affects not only physical and mental health but also places a huge economic burden on the family and society. The incidence of chronic pain is reported to be over 30% in China. 2 Current conventional methods for the treatment of chronic pain include drug therapy, minimally invasive therapy, psychotherapy, and physical therapy. 3 However, research has found that sympathetic nerves are involved in the maintenance of many kinds of chronic pain. 4 Therefore, inhibition of sympathetic hyperexcitability may improve the therapeutic effect, which may be related to the involvement of sympathetic nerves in regulating glial inflammation. 5 Among them, intervention of stellate ganglion (SG) is effective for pain in the head, face, neck, upper limbs, or upper chest. In this review, we summarize the clinical evidence available for the effectiveness of stellate ganglion intervention (SGI), and demonstrate clinical applications of SGI.

Stauntonia chinensis injection relieves neuropathic pain by increasing the expression of PSD‐95 and reducing the proliferation of phagocytic microglia

“…Neuropathic pain is often accompanied by neuroinflammation, and relieving neuroinflammation will effectively reduce pain. 29 , 30 Similar to the results of our previous study, 3 in the present study, we found that CCI mice had significant spinal cord neuroinflammation with increased expression of inflammatory cytokines TNF‐α, IL‐1β, and IL‐6. We used immunofluorescence and found that TNF‐α and IL‐1β colocalized with microglia.…”

Stellate Ganglion Blocks for Refractory Central Poststroke Pain: A Case Series

“…Stellate ganglion blocks have been used in various chronic pain conditions. 13 Although the exact mechanism of relief of central origin pain is unclear, the following hypotheses are proposed. The pathophysiology of the central lesion is multifactorial.…”

Advances in the Treatment of Neuropathic Pain by Sympathetic Regulation

“…It also branches into neighboring arteries, forming the internal carotid plexus, external carotid plexus, subclavian plexus, vertebral plexus, and pharyngeal plexus, and enters the thoracic cavity to participate in the formation of the cardiac plexus [31,32]. Therefore, stellate ganglion block has been widely used in the treatment of various vascular diseases with sympathetic nerve-mediated pain in the upper limb, head and neck, such as trigeminal neuralgia, chronic migraine, complex regional pain syndrome (CRPS), cephalic and facial postherpetic neuralgia [33][34][35][36][37]. For rare thalamic pain, a type of central pain after stroke, which is usually unbearable and uncontrollable and seriously affects the quality of life of patients, stellate ganglion block, as an effective treatment for sympathetic nerve regulation, can be an alternative treatment for thalamic pain after stroke.…”