Efficacy of Noninvasive Stellate Ganglion Blockade Performed Using Physical Agent Modalities in Patients with Sympathetic Hyperactivity-Associated Disorders: A Systematic Review and Meta-Analysis

Chun-De Liao, Jau-Yih Tsauo, Tsan-Hon Liou, Hung-Chou Chen, Chi-Lun Rau, Chun-De Liao, Jau-Yih Tsauo, Tsan-Hon Liou, Hung-Chou Chen, Chi-Lun Rau

Abstract

Background: Stellate ganglion blockade (SGB) is mainly used to relieve symptoms of neuropathic pain in conditions such as complex regional pain syndrome and has several potential complications. Noninvasive SGB performed using physical agent modalities (PAMs), such as light irradiation and electrical stimulation, can be clinically used as an alternative to conventional invasive SGB. However, its application protocols vary and its clinical efficacy remains controversial. This study investigated the use of noninvasive SGB for managing neuropathic pain or other disorders associated with sympathetic hyperactivity.

Materials and methods: We performed a comprehensive search of the following online databases: Medline, PubMed, Excerpta Medica Database, Cochrane Library Database, Ovid MEDLINE, Europe PubMed Central, EBSCOhost Research Databases, CINAHL, ProQuest Research Library, Physiotherapy Evidence Database, WorldWideScience, BIOSIS, and Google Scholar. We identified and included quasi-randomized or randomized controlled trials reporting the efficacy of SGB performed using therapeutic ultrasound, transcutaneous electrical nerve stimulation, light irradiation using low-level laser therapy, or xenon light or linearly polarized near-infrared light irradiation near or over the stellate ganglion region in treating complex regional pain syndrome or disorders requiring sympatholytic management. The included articles were subjected to a meta-analysis and risk of bias assessment.

Results: Nine randomized and four quasi-randomized controlled trials were included. Eleven trials had good methodological quality with a Physiotherapy Evidence Database (PEDro) score of ≥6, whereas the remaining two trials had a PEDro score of <6. The meta-analysis results revealed that the efficacy of noninvasive SGB on 100-mm visual analog pain score is higher than that of a placebo or active control (weighted mean difference, -21.59 mm; 95% CI, -34.25, -8.94; p = 0.0008).

Conclusions: Noninvasive SGB performed using PAMs effectively relieves pain of various etiologies, making it a valuable addition to the contemporary pain management armamentarium. However, this evidence is limited by the potential risk of bias.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of study selection.
Fig 1. Flow chart of study selection.
Fig 2
Fig 2
(A) Weighted mean differences in pain reduction on a 100-mm visual analog scale between noninvasive stellate ganglion blockade (SGB) and placebo groups from five controlled trials grouped according to the type of electrophysical modality used. (B) Subgroup analysis of high- and low-dose noninvasive SGB. Trial results plotted on the left-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds. US = ultrasound; TENS = transcutaneous electrical nerve stimulation.
Fig 3. Effect of noninvasive stellate ganglion…
Fig 3. Effect of noninvasive stellate ganglion blockade (SGB) on sympatholytic response compared with that of placebos in four controlled trials grouped according to the type of electrophysical modality used.
Trial results plotted on the right-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds. US = ultrasound; TENS = transcutaneous electrical nerve stimulation.
Fig 4. Effect of noninvasive stellate ganglion…
Fig 4. Effect of noninvasive stellate ganglion blockade (SGB) on hemodynamic changes compared with that of placebos.
Trial results plotted on the right-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds.
Fig 5. Standard mean difference in peripheral…
Fig 5. Standard mean difference in peripheral blood flow change between noninvasive stellate ganglion blockade (SGB) and placebo groups in three controlled trials grouped according to the type of electrophysical modality used.
Trial results plotted on the right-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds. US = ultrasound; TENS = transcutaneous electrical nerve stimulation.
Fig 6. Standard mean difference in the…
Fig 6. Standard mean difference in the peripheral temperature change between noninvasive stellate ganglion blockade (SGB) and placebo groups in four controlled trials grouped according to the type of electrophysical modality used.
Trial results plotted on the right-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds. US = ultrasound; TENS = transcutaneous electrical nerve stimulation.
Fig 7. Forest plot of comparisons of…
Fig 7. Forest plot of comparisons of outcomes between noninvasive stellate ganglion blockade and placebo groups: (A) short- and (B) medium-term effects on functional mobility and disability outcomes.
Trial results plotted on the right-hand side indicate effects favoring noninvasive SGB, and the combined effects are plotted using black diamonds. US = ultrasound; TENS = transcutaneous electrical nerve stimulation.
Fig 8. Publication bias plot.
Fig 8. Publication bias plot.
Effect size plot for trials with ultrasound (US, circle), transcutaneous electrical nerve stimulation (TENS, diamond), and linear polarized infrared light (square). The effect relative to the placebo is shown on the x-axis, and the standard error is shown on the y-axis. Substantial asymmetry was not observed in the funnel plot of pain reduction through visual inspection. Egger’s linear regression test results indicated no evidence of reporting bias among the studies (t = −0.376; p = 0.732).

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Source: PubMed

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