Editor's Note: For a number of years, there has been a discussion about the efficacy of stellate ganglion block (SGB) injections to treat - to cure - PTSD. The discussion has just returned as a "hot topic" with the breaking news announcement that the U.S. Army was commissioning a $2 million study for a controlled trial. An article about it in The Daily Beast quoted one military doctor as saying "Once people have the shot, they get dramatically better immediately." We wondered if this might be a case of "Too good to be true". Rather than just reporting this news and risking that people might view SGB as a miracle cure when in fact it might not be, we were motivated to contact Dr. David Yusko of the University of Pennsylvania, who is an expert in PTSD, to learn about the reality. This article is his perspective on the use of SGB and how it should be viewed - summarized by the headline above. -wnt


The science behind it

Posttraumatic Stress Disorder (PTSD) is a debilitating psychiatric condition characterized by symptoms that develop in response to being exposed to actual or threatened death, serious injury, and/or sexual violation. Those people suffering from PTSD after having survived a traumatic event continue to live as though the terror of the past is still ever present in their life today. Additionally, PTSD is almost never the only disorder afflicting a person. It is quite common, if not the norm, for individuals with PTSD to develop co-occurring psychiatric conditions, such as Major Depressive Disorder, an anxiety disorder, and/or a substance abuse problem. Furthermore, PTSD and its related sequalae are often chronic disorders that can prove to be difficult to ameliorate. This has been especially true in active duty military and veteran populations, where some of the most effective treatments for PTSD (e.g. prolonged exposure therapy and cognitive processing therapy) are typically less effective with combat related traumas. The search for ways to heal from traumatic experiences continues, and is just as relevant, if not more so today, as it was when our service members from the Vietnam war advocated for the creation of the PTSD diagnosis almost 40 years ago.

This leads us to the recent news reports involving the Department of Defense's two million dollar investment in researching the efficacy of stellate ganglion block (SGB) injections as a possible effective treatment for PTSD. While there is always reason to be excited by the possibility of a treatment that is as simple as receiving one injection, there is also reason to be weary and cautious. When something sounds too good to be true I immediately start to wonder if it is too good to be true. Let's look at what SGB is and what we currently know about it.

Briefly, and oversimplifying the treatment, the idea behind SGB injections is to introduce an anesthetic into the stellate ganglion – a block of nerves that sit near the base of the neck. The anesthetic is hypothesized to block this bundle of nerves from erroneously passing along messages from the parasympathetic nervous system to the central nervous system about the need for initiating the "flight or flight" response. Because people with PTSD have survived a life threatening event, they are predisposed to inaccurately perceiving threat and danger in their environment. This injection is supposed to help prevent their body from following through on activating biological systems that aren't actually needed. This is important because it is when the body responds to the perceived danger it reinforces the person's belief that what they perceived was in fact true – otherwise why would their body be responding in a way that is so similar to how it felt when the original trauma they survived occurred? When the body does not respond in a similar way it helps a person to challenge the inaccuracy of their initial perception and over time helps an individual better perceive the risks of the world around them. The question for the Department of Defense is if this injection actually works.

History of SGB injections

Here is what we know so far. Eugene G. Lipov MD, an Illinois anesthesiologist and pain management specialist, originated this approach to treat PTSD in 2007. Dr. Lipov and his team did a preliminary series of case studies, providing the procedure to eight PTSD patients with chronic symptoms. Lipov reported that six of the eight patients experienced significant, lasting relief, while the other two patients improved but to a lesser degree. These types of promising clinical case studies ultimately prompted funding by the U.S. Navy and Marine Corps to formally research the efficacy of SGB injections. A small cohort of military service members (a sample of 42 research participants with PTSD) were randomly assigned to receive either the active SGB injection or a placebo injection. Of the 42 participants, 27 received SGB and 15 received placebo. Results demonstrated that PTSD symptoms significantly decreased for both groups, however, the SGB injection did not demonstrate any better outcomes than the placebo injection. Therefore, the study suggested that the main outcome of the treatment is best explained by the placebo effect versus the active ingredients of the SGB injection.

Bottom line?

What does this all ultimately mean? My take away from this is that we really don't know and that is why the current study is being funded to more thoroughly examine the possibility that SGB injections might be helpful for military service members struggling with chronic PTSD symptoms. Should there be hope in this treatment? Absolutely - but be cautious! The one randomized clinical trial does not initially support the treatment as being better than placebo and therefore more research is necessary. It is healthy to hope for the best while also remembering that it is quite possible that this treatment will not be what so many of those suffering with PTSD, and so many of us who treat people with PTSD, want it to be.

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