Chicago, IL (PressExposure) April 03, 2007 -- Tamoxifen is a wonder drug when it comes to helping breast cancer survivors keep their cancer from returning, however, it comes at a price â hot flashes, which occur in some 80 percent of patients taking the drug. In fact, hot flashes are the reason most often cited by women who fail to complete their prescribed treatment.
A new treatment could change all that.
Eugene Lipov, MD, Director of Research, Alexian Brothers Hospital Network Pain Program, has pioneered a new approach to eliminating hot flashes that is hormone-free, highly effective, and has few side effects. Stellate ganglion blockade (SGB) affects the area of the brain that regulates body temperature and controls heat perception.
"We have found SGB to be very effective in the treatment of hot flashes in menopausal women, as well as those with estrogen depletion resulting from breast cancer treatment," says Dr. Lipov, who is also the Medical Director of Advanced Pain Centers (www.painmngt.com) in suburban Chicago.
Stellate ganglion block is a relatively straightforward procedure. Essentially it is an injection administered into the side of the neck at the location of a grouping of nerves called the stellate ganglia, which regulate blood flow and sweating. They are also connected to the body's thermostat, the hypothalamus and the insular cortex, which is the center for heat perception. Recent studies utilizing functional MRIs demonstrate that during a real-time monitored event, such as a hot flash, the insular cortex is instrumental in the hot flash activity.
The procedure is done by injecting an anesthetic (the same as used in an epidural during childbirth) into the right-side C6 ganglion in the neck, which resets the thermoregulating signals of the insular cortex in the brain. Interestingly, it was found that a left side ganglion block is not effective.
âWe hypothesize that the stellate ganglion block provides relief from hot flashes by allowing the body temperature control and perception to reset and function normally. Nineteen out of 20 patients had at least an 80 percent decrease in hot flashes for a minimum of two weeks following SGB," Dr. Lipov says (www.hotflashescure.com).
While the period of time SGB is effective for hot flash control is variable, relief has been reported as ranging from several weeks to 18 months. Most patients can sleep through the night the day after the procedure. The youngest patient treated was 36 and the oldest was 69.
"SGB is a welcome treatment to help women remain compliant with their tamoxifen regimen,â notes Dr. Linda Holt, Associate Professor, clinical obstetrics and gynecology, Northwestern University.
Ideally, this procedure is done in the doctorâs office, accompanied by appropriate monitoring and preparation. It should not be done without x-ray guidance. Side effects are exceedingly rare; 1.7 out of 1000 versus 13 out of 100 for Neurontin, a drug commonly prescribed for treating hot flashes. However, if a side effect were to occur, it would happen in front of the doctor, where immediate help is available.
SGB is not a new methodology as it has been used extensively to treat severe pain since 1940.
"SGB has a safety record going back more than 70 years," notes Dr. Lipov. "Utilizing it for menopausal symptoms has the potential to give women a highly effective alternative to drugs carrying unwanted side effects.â
Dr. Lipov will publish an article about SGB in early summer in the British peer-reviewed journal Medical Hypotheses. The original article reporting the excellent response of women to SGB was published in the peer-reviewed publication Journal of Womenâs Health in 2005.
In addition, Dr. Lipov is currently undertaking an Institutional Review Board (IRB) clinical study collecting and quantifying the effectiveness and duration of the block on breast cancer survivors.
"If the effectiveness of this can be confirmed on a large scale study, this would provide women who suffer with intractable hot flashes with an effective, potentially long-lasting means of relieving their symptoms,â Dr. Lipov explains. âThe procedure, as a model, can be easily duplicated and, with brief training, could be utilized by health care professionals across the country. The impact on women, particularly breast cancer survivors, would be profound, allowing for far better quality of life.â