Novel PTSD Treatment – Stellate Ganglion Block

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What is Post Traumatic Stress Disorder? 

PTSD is a mental health condition that’s triggered by a terrifying event; either by experiencing it or by witnessing it.  

Symptoms may include:

  • Flashbacks
  • Nightmares and sleeping difficulties
  • Severe anxiety and fear
  • Uncontrollable thoughts about the event
  • Anger and aggressive behavior
  • Sadness or depression
  • Hypervigilance or always being on guard
  • Avoiding activities and places

 

How is PTSD treated? 

The mainstay of PTS therapy has been medications such as antidepressants and psychotherapy.  These are often not very effective alone partly due to participants dropping out of therapy, as many psychotherapies require one to relive or talk about the traumatic event causing many of the symptoms above.  The goal always has been and always will be to reduce the risk of suicide and to regain function.

 

Are there more effective treatments available? 

There are other treatment options for PTS. One is a Stellate Ganglion Block (SGB).  This injection is not new and has been around since the 1920’s. It was originally used for pain and still is. The SGB was found by accident to treat depression in the 1940’s, and similarly, to treat PTS in the 1990’s.  The stellate ganglion is part of our central nervous system that communicates with the Amygdala, which is the emotional storage center of our brain.  The amygdala stores emotions associated with fear and anxietyexcitementangersadness, the fight or flight response. With PTS, the amygdala exaggerates the emotional response. This injection became famous when Dr. Sean Mulvaney, a military pain doctor, appeared on 60 minutes discussing its usefulness in treating PTSD in late 2019, however, Dr. Eugene Lipov had pioneered using this injection for PTS years earlier. This injection is performed with x-ray fluoroscopic or ultrasound image guidance and is performed by directing a needle to a nerve bundle sitting near the cervical spine in your neck.  It is a safe procedure in experienced hands.

 

How does the SGB work? 

The SGB works by blocking the emotional response caused by the triggering event, thoughts, nightmares, or sounds.  It may reset the amygdala.  Studies show that it has been very successful at restoring the normal functioning of the amygdala and the stellate ganglion to pre-trauma settings.  Patients often feel very calm and relaxed immediately following this injection. Most often, we block the right SGB because the right side of the amygdala appears to be more responsible for the emotions associated with PTS.  Occasionally, a left sided SGB is needed as well.  Sometimes the reset is long-lasting.  Other times, the injection will need to be repeated.

 

To summarize, the SGB works to reduce or eliminate the anger, fear, anxiety, depression, sadness, hypervigilance, and the fight or flight response associated with PTS. It does NOT remove or reduce the thoughts or the nightmares, just the emotional response to them.  Psychotherapy and treatments such as EMDR in conjunction with the SGB may be much more effective at processing thru the traumatic event and memories after the injection.

Our experts at Southwest Pain Management in Irving offer this injection treatment for people suffering with PTSD.

Some studies supporting the SGB treatment for PTSD

  1. JAMA Psychiatry. 2020;77(2):130-138. doi:10.1001/jamapsychiatry.2019.3474

 

 

 

 

AUTHOR:  Dr. Robert Groysman, MD

Dr. Robert Groysman is a Diplomate of the American Board of Anesthesiology and American Board of Pain Medicine, and a proud member of the Texas Pain Society, American Society of Interventional Pain Physicians, and Spine Intervention Society. He participates in research, frequently attends professional conferences, and continually adopts new procedures and techniques for relieving pain into his practice at Southwest Pain Management. 

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