Abstract ID: A24
Abstract Title: Ganglionic Local Opioid Application (GLOA) in Headache and Facial Pain
Authors: Harris C1, Hamid B2, Rosenquist R3, Schultz-Stubner S4
Des Moines Iowa USA
Poster Type: Poster
ABSTRACT BODY
Introduction:
Ganglionic local opioid application (GLOA) has been utilized as a treatment of neuropathic and sympathetically-mediated pain syndromes. Mays et al. described initial work with morphine at the stellate ganglion for upper extremity sympathetic pain in 1981. In 1998, Maier coined the term GLOA as a diagnostic and therapeutic modality for generalized pain syndromes of the head and face.
We present a series of three cases, in which the application of Buprenorphine to the stellate ganglion demonstrated benefit in the treatment of chronic daily headache and persistent idiopathic facial pain when conventional treatment modalities had failed.
Materials and Methods:
After the risks and benefits were discussed, informed consent was obtained. An IV is started, and the patient is placed in a supine position. Monitors including noninvasive blood pressure cuff, electrocardiogram, and pulse oximeter are applied. The side corresponding to the pain is sterilely prepped and draped on the anterior aspect of the neck. A 25-gauge 1.5 inch needle is attached to minimum volume tubing with a three cc syringe. Two fingers are used to palpate the cricoid cartilage then swept laterally and dorsally while displacing the carotid sheath laterally. After identifying the C6 tubercle, the two fingers are spread apart in a cranial and caudal direction. The needle is placed between the two spread fingers and advanced to contact the transverse process of C6. The needle is then withdrawn 1-2 mm. After careful negative aspiration, two cc of normal saline with 0.045 mg of Buprenorphine Hydrochloride is injected slowly.
Results:
In each case, we demonstrated reduction in the intensity and frequency of headache as well as the use of opioids. More importantly, each case has demonstrated an improved functioning and quality of life.
Discussion:
In this case series we presented two individuals with chronic daily headaches and one with atypical face pain. While the contribution of the autonomic nervous system in the development and maintenance of different pain disorders such as complex regional pain syndrome is not fully understood, it is even less clear in the pain syndromes of the head and region such as in headache and facial pain.
Stellate ganglion blockade has been utilized with a varying degree of success for an assortment of pain disorders of the head and neck such as complex regional pain syndrome, post-herpetic neuralgia, cluster headache, migraine headache, trigeminal neuralgia, postoperative ocular pain, herpes zoster ophthalmicus, and neuropathic orofacial pain.
To our knowledge, this is the first case series in the English literature of utilizing GLOA at the stellate ganglion for neck and face pain.
Conclusion:
Although the exact mechanism of action for GLOA has yet to be elucidated, this work supports the role of the autonomic system in chronic pain conditions of the head and face, the presence of opioid receptors in the sympathetic ganglia, and the role of opioids in modifying ganglionic transmission by changing the excitability of the stellate ganglion. GLOA may be a viable treatment option for patients with unremitting headaches and facial pain who have failed conventional treatment modalities.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A24