Harvard Women's Health Watch

In the journals: Nerve block quells hot flashes in women with breast cancer

In the journals

Nerve block quells hot flashes in women with breast cancer

Hot flashes and sleep disturbances are a common and often severe side effect of drugs used to treat and prevent breast cancer, including tamoxifen and aromatase inhibitors. Estrogen is the best way to relieve hot flashes, but it can fuel breast cancer growth, so women who've had breast cancer or are at increased risk for it should usually avoid hormone therapy. Other options — less effective and with side effects of their own — include herbal therapies and prescription medications such as antidepressants and the anti-epileptic drug gabapentin. Now, in a small pilot study of breast cancer survivors, researchers have found they can nearly eliminate severe hot flashes and nighttime awakenings, with virtually no side effects, by anesthetizing certain nerves in the neck — a procedure called stellate ganglion blockade (SGB). The findings, published in Lancet Oncology (June 2008), may also have implications for menopausal women with disabling hot flashes.

While its application to hot flashes is relatively new, SGB has been safely used for years to relieve pain in the face, head, neck, and upper arm. During the procedure, an anesthetic is injected into the stellate ganglion (see illustration), a cluster of nerve cells in the neck that help regulate blood flow and are linked to brain regions involved in body temperature regulation.

Stellate ganglion blockade

The stellate ganglion (a group of nerve cells) is connected to parts of the brain involved in core body temperature regulation. An anesthetic injection into the stellate ganglion reduces hot flashes and night awakenings, possibly by "resetting" parts of the nervous system.

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