Goebel Andreas, Lawson Andrew, Allen Steve, Glynn Chris
The Pain Relief Unit, Churchill Hospital, Oxford OX3 7LJ, United Kingdom.
Eur J Pain. 2008 Apr;12(3):266-74. doi: 10.1016/j.ejpain.2007.05.009. Epub 2007 Jul 16.
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.
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.
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.
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.
ISRCTN59287260; http://www.controlled-trials.com/
向交感神经节注射低剂量丁丙诺啡，即所谓的“GLOA”（神经节内局部阿片类镇痛），在欧洲多个中心用于治疗慢性疼痛。目前尚不清楚在慢性疼痛综合征中临床观察到的GLOA效应是否归因于丁丙诺啡在神经节的特定作用。我们评估了GLOA联合肌肉注射生理盐水是否比反向操作（向星状神经节注射生理盐水联合肌肉注射丁丙诺啡，即SSB）更有效。
我们设计了一项随机、双盲、对照交叉试验来治疗慢性上身疼痛综合征患者。患者首先接受GLOA或SSB治疗。在注射前以及注射后的最初8小时和6天内，使用疼痛日记评估疼痛情况，并将其表示为注射后与注射前疼痛的相对疼痛强度。
GLOA和SSB注射后的中位相对疼痛强度没有差异。仅4例患者在接受SSB治疗后的最初8小时内报告相对疼痛水平较低，<50%。4例患者未完成试验并被排除。1例心肌病患者在接受GLOA治疗后出现急性发汗和疲劳，但生命体征保持稳定。
我们未能证明GLOA优于SSB。我们的结果表明，单次GLOA注射后临床观察到的效应不太可能是由于丁丙诺啡对星状神经节的特定作用。据此对GLOA的疗效提出质疑。应谨慎考虑在心肌病患者中使用GLOA。
ISRCTN59287260；http://www.controlled-trials.com/
