Could a Neck Injection Ease Tough-to-Bear Hot Flashes?10/14/13
SATURDAY, Oct. 12 (HealthDay News) -- A shot in the neck may
curb extreme hot flashes associated with menopause, a small new
Injecting a local anesthetic into an area of the neck that
communicates with the brain's temperature regulation zone was
associated with a 50 percent reduction in hot flashes among women
with moderate to severe symptoms, the researchers reported.
Since research over the last decade has suggested that taking
hormone replacement therapy to control menopausal symptoms may be
associated with increased risk for heart disease and cancer, many
women have been searching for a safe and effective non-hormonal
means of reducing hot flashes.
The anesthetic treatment isn't designed for everyone with hot
flashes. It's intended for those struggling with truly troubling
hot flashes that occur regularly, affecting quality of life, said
study author Dr. David Walega, chief of the division of pain
medicine at Northwestern University Feinberg School of Medicine in
"This is for people with multiple drenching sweats, women who can't function in the workplace, who have extreme anxiety preceding the hot flash. And when that happens several times a day, we also see anxiety and depression," explained Walega. Some breast cancer patients stop taking their medication -- tamoxifen -- because it causes hot flashes, he added.
Hot flashes are sudden feelings of heat or warmth starting in
the face and extending to the neck and chest area, sometimes
accompanied by sweating and flushing of the skin. They are
associated with menopause, but can also occur in patients taking
estrogen-blocking medications, typically for breast or prostate
cancer. Walega estimated that hot flashes affect more than 80
percent of menopausal women.
To deliver the treatment, the physician uses guided imaging to
inject a local anesthetic into what is called the stellate
ganglion, an area between the thyroid gland (around the "voice
box") and the carotid artery. "The patient feels a sense of intense
pressure from the physician's finger [guiding the needle], and the
pain is moderate," said Walega. "In 30 seconds, we're done."
The researchers got the idea of attacking extreme hot flashes by
treating the stellate ganglion from unintended consequences of a
pain study published in
The Lancetin 2007. "Patients reported their pain was still
there, but their hot flashes were gone," Walaga said.
For this study, scheduled for presentation Saturday at the
American Society of Anesthesiologists annual meeting in San
Francisco, the researchers recruited 40 women between 35 and 65
years old. All were either in natural or surgically induced
menopause (when the ovaries are removed).
Half of the women received a stellate ganglion blockade
injection of bupivacaine hydrochloride, a local anesthetic. The
others were given a placebo, an injection of sterile saline.
Participants kept track of their hot flashes for two weeks
preceding the injection and six months afterward.
The researchers found that stellate ganglion blockade reduces
the incidence of hot flashes by half, especially in women with
moderate or severe hot flashes, and the benefits appear to last for
at least six months. Subjects also reported experiencing less
depression after getting the bupivacaine injections, and they
demonstrated improved verbal recall of spoken words.
Walega said the treatment is safe when done by specially trained
physicians using X-ray fluoroscopy to guide the injection. The
stellate ganglion sits near the carotid artery, the vertebral
artery and the spinal cord. "Injecting any of those arteries with
anesthetic could cause a seizure and loss of consciousness, and it
could do damage to the spinal cord," he explained. As for the risk
of radiation exposure from the fluoroscopy, it is equivalent to
that of a chest X-ray, he added.
Why might these injections work? Walega said he thinks the
ganglion may play a role in turning certain nerves on or off. "It's
complex and there's so much else we don't know," Walega said. "We
might be resetting the thermostat." Walega now plans to do a larger
study with more than 200 participants, he noted.
Dr. Grace Forde, an attending physician and pain management
specialist at Syosset Hospital in New York, noted that a large
percentage of the patients receiving the placebo also reported an
improvement in their hot flashes. "Invasive procedures often have a
much stronger placebo effect," she noted.
Walega estimated that the treatment, if proven effective in a
larger study, would cost between $750 and $1,000.
Forde, who was not associated with the study, said she thinks
the benefits of the treatment probably outweigh the risks. "You
can't put a price on quality of life. I personally think it's worth
Because this study was presented at a medical meeting, the data
and conclusions should be viewed as preliminary until published in
a peer-reviewed journal.
Learn more about menopause from the
U.S. Centers for Disease Control and
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