It may seem too good to be true, but it is based on real science
What is PTSD? How does Stellate Ganglion Block work?
Post-Traumatic Stress Disorder (PTSD) develops in response to being exposed to extreme stress, serious injury, and/or sexual trauma. The symptoms of PTSD present themselves as an assortment of psychiatric conditions: Nightmares, severe anxiety, insomnia, hyper-vigilance and over reactivity being the most pronounced. The sympathetic nervous system (“fight or flight”) has been long known to play a part in PTSD. It is believed that extra nerves of this system sprout or grow after extreme trauma leading to elevated levels of norepinephrine (an adrenaline-like substance) which, in turn, over activates the amygdala (the fear center of the brain). This chain of events results in PTSD symptoms that may persist for years .
A part of the sympathetic nervous system, called Stellate Ganglion (a collection of nerves in the neck) seems to control the activation of the amygdala. A recent innovation offers potential in rapidly treating symptoms of PTSD for a prolonged period of time. Placing an anesthetic agent on the stellate ganglion, in an anesthetic procedure called Stellate Ganglion Block (SGB) can relieve the symptoms of PTSD in as little as 30 minutes and last for years. SGB “reboots” the sympathetic nervous system to its pre-trauma state, similar to a computer reboot. In the brain, norepinephrine levels are rapidly reduced and the extra nerve growth is removed. SGB is an anesthetic procedure that has been performed since 1925 and is considered a low risk pain procedure done under x-ray guidance.
Research results have been impressive. Incumbent PTSD treatments can take from months to years to work with success rates of under 40%. Overall SGB success rates have averaged 70-75% over the first nine years of use. In collaboration with neuroscientists and clinical observations, the author has modified the SGB procedure, resulting in current success rates in the 85 to 90% range.
Wider acceptance of Stellate Ganglion Block (SGB) as a PTSD treatment began in 2008 when “The Annals of Clinical Psychiatry” published the article “Cervical Sympathetic Blockade in a Patient with PTSD”. Subsequently, four military institutions ( Walter Reed Hospital, San Diego Naval Hospital, Tripler Hospital, and the Long Beach California Veterans Administration Hospital) have successfully used SGB. The Long Beach VA doctors were able to demonstrate objective evidence of deactivation of the amygdala by examining PET scans (positron emission tomography) taken both before and two days after SGB. These promising results prompted the Department of Defense to commission a three-year, $2 million single blinded placebo control study of 242 active duty personnel diagnosed with PTSD. The study began late in 2015, and formal publication of the results are expected by summer 2019.
It is important to understand that SGB is not a cure for PTSD; however, the symptoms may be controlled for a long time by using this approach. The longest follow-up available to date is a soldier that had severe PTSD from combat in Iraq. He was treated 10 years ago and is still doing well.
Patients do best when they adhere to a proper regimen of after care under the supervision of psychiatric professionals. CBT (Cognitive Behavioral Therapy), reduction or elimination of psychiatric medications, and meditation are commonly recommended. Reappearance of symptoms can occur if other trauma(s) are inflicted after SGB, if the patient is genetically predisposed to be sensitive to stress, or if the patient does not comply with the after-care protocol. Should symptoms reappear, then another SGB is likely to alleviate them.
History of SGB injections
The Stellate Ganglion Block was first used in the United States in 1925. The original purpose of the procedure was to provide relief of chronic pain. It has been administered millions of times since then, all across the globe. SGB was first used for depression in 1945 in The Cleveland Clinic. Unfortunately, its psychiatric impact potential was forgotten. Then in 1998 , a Finnish physician treated a patient who was suffering from both severe hand sweating and PTSD. The procedure for hand sweating involved modulating the sympathetic nervous system in the upper chest (clipping T2 ganglion). Much to the doctor’s surprise, the patient reported relief of hand sweats as well as relief from his PTSD symptoms. During my research I realized that the Finnish doctor’s PTSD success could be achieved more easily and safely by blocking the sympathetic nervous system in the neck rather than the chest. Since 2007, I have performed over 550 SBG procedures for PTSD. An additional 2,000 SGB procedures have been performed by colleagues, mostly doctors in the US Army.
Bottom line?
Stellate Ganglion Block (SGB) is not a cure for PTSD. However, it is a highly effective, well tolerated, fast acting, inexpensive biologic technique that provides prolonged relief from the debilitating symptoms of PTSD. It will likely become a large part of the solution for patients with PTSD which include veterans, victims of sexual assault, first responders, and victims of crime and others.
Editor’s Note: Dr. Lipov, an anesthesiologist and pain management specialist, is a recognized expert in the biological causes as well as treatment of PTSD and has written extensively on PTSD, SGB, and other pain-related subjects. Dr. Lipov published the first of his many articles on SGB / PTSD in 2008. The first military physician to use SGB to treat PTSD was Dr. Brian McLean, a pain management specialist practicing at Walter Reed Hospital at that time. Dr. McLean was alerted to the novel uses of SGB by Dr. Sean Mulvaney, a fellow military physician who appeared in the 60 Minutes segment. Drs. McLean and Mulvaney have collectively performed ~ 2,000 SGB / PTSD procedures since each learned of it, saving many lives. A video with Dr. Lipov and Dr. McLean detailing the origins of the SGB as a highly efficacious and rapid treatment for removing symptoms of PTSD can be found here: https://youtu.be/Tp8SHn_eo9U. This article is an update to the research Anxiety.org published several years ago. – wnt
Dr. Eugene Lipov is a board-certified anesthesiologist who specializes in pain management. After completing an M.D. at the Feinberg School of Medicine at Northwestern University in 1984, he went on to complete advanced anesthesiology training at the University of Illinois at Chicago and at Rush University’s Medical Center. He has specialized in interventional pain medicine for more than 28 years, and was the founding member and first president of the Illinois Chapter of the American Society of Interventional Pain Physicians (ASIPP). He concurrently serves as Director of Research at Northwest Community College and as Medical Director of Advanced Pain Centers, which received the 2007 Chicago Innovation award. Dr. Lipov is also the Founder and Chief Medical Officer of The Stella Center, whose mission is to offer relief to trauma and related symptoms by providing safe, convenient, and comfortable patient access to the Stellate Ganglion Block procedure.
In 2007 Dr. Lipov pioneered the use of Stellate Ganglion Block for the treatment for post-traumatic stress disorder (PTSD). In 2010, he testified on PTSD treatment before the U.S. House Committee on Veterans’ Affairs. In collaboration with neuroscientists, he has become the world’s leading authority on the physiology of PTSD. He has published his findings on PTSD in Biological Psychiatry, Current Psychiatry, Military Medicine, Pain Research & Treatment, Psychiatric Annals, the Journal of Anesthesia & Clinical Research, the Journal of Trauma and Treatment, the Lancet and the World Institute of Pain. In addition, his work has been written about in the Wall Street Journal, the Los Angeles Times, the Chicago Tribute, USA Today, Wired, Playboy, Univision, Stars & Stripes, and it has been featured on ABC, NBC and WGN.
