Buprenorphine injection to the stellate ganglion in the treatment of upper body chronic pain syndromes.
BACKGROUND
The injection of low dose buprenorphine to the sympathetic ganglia, termed "GLOA", Ganglionide Local Opioid Analgesia, is used to treat chronic pain in several European centres. It is not known whether the clinically observed GLOA effect in chronic pain syndromes is due to a specific effect of buprenorphine at the ganglia. We assessed whether GLOA, plus intramuscular saline, was more efficacious than the reverse, saline injection to the stellate plus intramuscular buprenorphine, termed SSB.


METHODS
We devised a randomized, double-blinded, controlled crossover trial to treat patients with chronic upper body pain syndromes. Patients first received either GLOA or SSB. Pain was assessed using pain diaries both before injection and over the first 8h and 6days afterwards, and was expressed as relative pain intensity post versus pre-injection pain.


RESULTS
The median relative pain intensity after injections did not differ between GLOA and SSB. Four patients reported a low, <50%, relative pain level over the first 8h after SSB only. Four patients did not complete the trial and were excluded. One patient with cardiomyopathy became acutely diaphoretic and fatigued after GLOA, his vital signs however remained stable.


CONCLUSIONS
We failed to show a superiority of GLOA over SSB. Our results suggest it unlikely that the clinically observed effect after a single GLOA injection is due to a specific action of buprenorphine at the stellate ganglion. The efficacy of GLOA is hereby questioned. The use of GLOA in patients with cardiomyopathy should be cautioned.


BACKGROUND
ISRCTN59287260; http://www.controlled-trials.com/
Goebel
Andreas
A
The Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ, United Kingdom. andreasgoebel@rocketmail.com
Lawson
Andrew
A
Allen
Steve
S
Glynn
Chris
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use*; D001340:Autonomic Nerve Block; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005157:Facial Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007267:Injections; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy*; D010147:Pain Measurement; D020069:Shoulder Pain / Q000188:drug therapy*; D013233:Stellate Ganglion / Q000187:drug effects / Q000503:physiopathology; D017779:Sympathetic Fibers, Postganglionic / Q000187:drug effects / Q000503:physiopathology
D018712:Analgesics, Non-Narcotic; D002047:Buprenorphine