Reset the Autonomic Nervous System non-invasively with Sphenopalatine Ganglion Blocks.
A method of improving quality of health while reducing the costs of medical care and the overuse of pharmaceuticals with associated reduction in negative side effects. Unfortunately, Insurance companies are behaving in a penny wise -pound foolish way when it comes to coverage of Sphenopalatine Ganglion Blocks. They see the blocks as an expense rather than looking for ways to make SPG Blocks a resource to lower health care expenses for both patients and insurance companies. The biggest danger of SPG Blocks is that they will not be utilized appropriately and patients will suffer from both lack of treatment and negative siide effects of other treatments.
The Sphenopalatine Ganglion or SPG is the largest parasympathetic ganglion of the head and contains both sympathetic nerves from the Superior Cervical Sympathetic Chain and parasympathetic nerves whose cell bodies are in the Sphenopalatine Ganglion.
Resetting the autonomic nervous by treating the Sphenopalatine Ganglion with anesthetic (cocaine) was first described in 1909 by Greenfield Sluder for the treatment of Sphenopalatine Neuralgia or Sluder’s Neuralgia. This is commonly thought to bee either cluster headqahes or a TMD dysfunction today.
After the initial use of the block in 1909 it was investigated for treating a wide variety of head, neck and facial pains. There were thousands of blocks done for a wide variety of disorders and dysfunctions with an amazingly high degree of success and minimal reports of negative side effects.
In 1930 Hyram Byrd MD published a paper “Sphenopalatine Phenomena” in the “Annals of Internal Medicine” or JAMA that summed up results of 10,000 Sphenopalatine Ganglion Blocks in 2000 patients. Dr Sluder later went on to become the head of Otolaryngology at Washington University School of Medicine in St Louis where he continued his research into this remarkable block. He later published a medical textbook “Nasal Neurology” much of which was devoted to this subject.
While there were universally positive results utilizing SPG Blocks they almost became part of “Forgotten Medicine” the waste bin where valuable life changing medicine frequently becomes lost.
Did this happen because of problems associated with the procedure? Was it because it was t expensive or dangerous? How is it that successful treatments fall to the wayside?
In the case of Sphenopalatine Ganglion Blocks it was the rise of the pharmaceutical empires and the switch in medicine from preventing disease and improving health to the reliance on “Magic Pills” to restore health. At the same time there were changes in diagnostic protocols where CAT Scans, MRIs and many other electro-diagnostic techniques were evolving.
The medical profession changed drastically over a period of decades as medicine embraced the pervasive use of pharmaceutical treatments and diagnostic medicine.
The SOAP approach to medicine of “Subjective, Objective Assessment and Plan” with Subjective being initially the single most important important part of a medical examination was turned on its head by medical insurance companies who did not reimburse doctors well for talking to patients.
This led to an enormous over reliance on medical testing. Medical malpractive attorneys also played their part with an avalanche of questionable lawsuits. Physicians could be severely burned if they did not order a “crucial test”. This reliance on testing changed medicine forever as diagnostic tests were often done more to protect the physician than to improve the health of the patients.
Sphenopalatine Ganglion Blocks may have been lost had it not been for an octogenarian ENT physician in New York City, Dr Milton Reder. A physician of an earlier era Dr Reder used SPG Blocks to treat a wide variety of health issues.
In 1986 Gerber wrote a book “Miracles on Park Avenue” profiling the work of Dr Milton Reder with patients who had lost hope in medical treatment reporting miraculous cures when seen by Dr Reder. His secret weapon was Sphenopalatiine Ganglion Blocks done with a small piece of cotton soaked in a 10% solution of cocaine. Cocaine was frequently used in ENT practice as an anesthetic and for it use in controlling bleeding.
The Sphenopalatine Ganglion is a small part of the brain located out of the main space of the calvarium in the Pterygopalatiine Fossa where it is accessible without invasive techniques. The nasal wall of the Pterygopalaytine Fossa is paper-thin bone covered by mucosa that permits cocaine and other anesthetics such as lidocaine to pass thru the tissues to the ganglion. The Sphenopalatine Ganglion is also known as the Pterygopalatine Ganglion due to it’s position it the Pterygopalatine Fossa.
Following the publication of “Miracles on Park Avenue” there was a slow resurgence of the use of Sphenopalatine Ganglion Blocks (SPG Blocks) to treat a wide variety of disorders including eye pain, nose pain, ear pain, sinus pain, headaches, migraines, TMJ disorders, Cluster headaches and other TAC’s.
The development of nasal cathers used to deliver anesthetic created new methods of delivering these blocks. Three commercial devices specifically designed for delivering anesthetic to the Sphenopalatine Ganglion are on the market. The Sphenocath is the first and oldest, the Allevio which is very similar to the Sphenocath and the TX360 which is used in the MIRX protocols. These devices put profits back into the technique and studies were again done showing how effective SPG Blocks.
All three of these products are basically “fancy nasal squirt guns” that deposit anesthetic over the area of the Sphenopalatine Ganglion. Except for ease (comfort) of delivery there is no evidence of superiority over the original techniques of Sluder and Byrd. These new studies led to protocols for delivering SPG Blocks multiple time to eliminate or decrease symptoms. The patient will remain supine for 10-20 minutes for the anesthetic to stay in the region of the ganglion.
The use of a Trans-Nasal Cotton-Tipped Nasal Catheters (TNC-TNC or TNC) is a return to the original concept of a pledget of cotton soaked in 10% cocaine and delivered on a narrow wire. The cotton-tipped nasal catheter offers continual delivery of the aesthetic to the ganglion via capillary action continually supplying more anesthetic even if the patient is upright or mobile. This allows the patient to function in all daily activities and increase the time exposure to the anesthetic. It also makes a very safe solution of 2% lidocaine as or more effective than 10% cocaine. It also avoids issue of the cocaine being diverted for recreational use.
When SPG Blocks are done in physician offices or Emergency Departments in hospitals they become expensive to the health care system and to the patient. The patient also suffers needless visits to physician’s offices and to the ER.
The beauty of the Cotton-Tipped Nasal Catheter is that most patients can be taught to Self-Administer SPG Blocks. This allows the blocks to be used prophylactically at home and at the first signs of a problem with virtually no negative side effects.
Side effects do occur with SPG Blocks but generally they are positive in nature. Recent articles have detailed how approximately 1/3 of patients with essential hypertension are cured with Sphenopalatine Ganglion Blocks. This is a remarkable side effect that can save hundreds of millions of dollars in medication costs for treating essential hypertension. When one considers cardiac and pulmonary effects of hypertension the saving rapidly grow.
I believe that the method of reducing essential hypertension is by turning down the Sympathetic division of the Autonomic Nervous System and allowing the Parasympathetic to become dominant. Sympathetic overload is frequently related to high levels of chronic stress. Chronic Stress turns on out “Fight or Flight” reflex and prolonged stress can lead too many disorders including adrenal fatigue and hypertension. The SPG turn off the Sympathetics allowing the Parasympathetic reflexes to rule, the so-called “Rest and Digest” reflex or the “Feed and Breed” reflex. It stimulated the same system that is stimulated paying with puppies, kittens or babies.
The reduction of chronic stress is the basis of all Cognitive Behavioral Therapy and the target of countless medications. Sphenopalatine Ganglion Blocks can drastically reduce and/or eliminate anxiety in many patients. It can also reduce symptoms like hives and tension headaches associated with stress.
Hans Selye described the negative effects on all aspects of life in his 1950 book “The stress of Life” which is when chronic stress was first seen as a cause of disease. Stress if often blamed for reproductive and hormonal problems. The autonomic nervous system is the system of romantic love and mating. In my very limited experience the expression of sexual desire and/or satisfaction is especially active in females. I suspect that in males the “Spreading of Seed” or the “Genetic Imperative” is more of a Sympatheic response. The receptive females are in their Parasympathetic response.
Caring for offspring is a Parasympathetic response but competing for a mate is absolutely Sympathetic especially in males.
SPG Blocks are also helpful is relieving severe anxiety associated with Sympathetic Overload and should be considered an aid in the treatment of phobias and PTSD. The Stellate Ganglion Block (SGP) has been shown to “Cure PTSD” with a single shot given to treat shoulder pain related to Chronic Regional Pain Syndromes (Reflex Sympathetic Dystrophy) The effect of the blocks is to turn off the sympathetic system causing pain and maintaining PTSD. The consideration that PTSD is actively maintained on an ongoing basis by sympathetic nervous system should open new avenues of treatment. This is a current area of study that was recently funded by the Veterans Affairs Agency and the Military.
The Spenopalatine Ganglion carries fibers of the Upper Cervical Sympathetic Chain while the Stellate Ganglion carries the fibers of the Inferior Sympathetic Chain.
SPG Blocks can be used for Trigeminal Neuralgia as reported in “Evaluation of Sphenopalatine Ganglion Blockade via intra oral route for the management of atypical trigeminal neuralgia” by Coven and Dayisoylu.