New Treatment for PTSD? Encouraging Results From Stellate Ganglion Block Study

Epidemiologist Dr. Maryam Navaie led a study recently published in the Journal of Anesthesia and Clinical Research showing how local anesthetics can help rapidly improve persistent symptoms of post-traumatic stress disorder.

Researchers from Advanced Health Solutions and military psychiatry and anesthesiology experts participated in the study, which consolidated all published case reports and case series on stellate ganglion block to treat patients who have tried and failed conventional PTSD therapies. The outcomes are exciting for this relatively new treatment.

"This is a small step forward towards understanding and the acceptance of a commonly performed interventional pain procedure — SGB — for the treatment of PTSD given the fact that the current options are inadequate," said study co-author Salahadin Abdi, MD, PhD, professor and chairman in the department of pain medicine, division of anesthesiology and critical care at The University of Texas MD Anderson Cancer Center.

There are 23 cases studied, with the majority being male and active duty service members or veterans. But there were also cases in the non-military population.

The patients underwent one year of psychotherapy, pharmacotherapy or both without relief and comorbidity was reported in 87.5 percent of the published cases. Half of the patients had depression, 33 percent had chronic pain, 29 percent had insomnia and 21 percent reported alcohol abuse. Seventy-one percent of the patients had one SGB and 29 percent received multiple SGB.

Nearly all patients received injections of 7cc of 0.5 percent ropivacaine or bupivacaine. The results were as follows:

•    75 percent reported clinically meaningful improvements — a 30 percent or more decline in PTSD symptoms — after SGB
•    Statistically significant difference in PTSD scores pre- and post-SGB were observed in all cases
•    PTSD improved by 50.4 percent on average for patients with one SGB
•    PTSD improved 69 percent for patients with multiple SGB
•    Average improvement was measured over 39 days — 29 days for cases with one SGB and 84.75 for cases with multiple SGB
•    No complications were reported associated with SGB

"Our article shows that SGB rapidly reduces chronic PTSD symptoms in patients treated across the country by Army, Navy and civilian doctors alike. The growing evidence-base from multiple credible institutions caring for active duty service members, veterans and civilians who suffer from PTSD is consistent and impressive when examined in its totality," said Maryam Navaie, DrPH, president and CEO of Advance Health Solutions and lead study author.

This study could have a huge clinical, social and economic impact on people suffering from PTSD. SGB's fast treatment cycle could be an alternative for other evidence-based therapies that have a high-rate of attrition like psychotherapy or potential for abuse like medication use.

"While some treatments for PTSD do exist, many sufferers refuse to go, either because they worry about re-exposing themselves to trauma or about medication side effects," said Colonel Elspeth Cameron Ritchie, MD, MPH, chief medical officer at the Department of Behavioral Health in Washington, DC and co-author of the study. "One of the exciting aspects of the stellate ganglion procedure is that for some, it leads to a dramatic reduction of symptoms in a very short period of time with minimal or no side effects."

However, more research on larger patient populations will show more clearly how SGB can impact people with PTSD. "If this works, SGB is just about the ideal treatment for PTSD. We found that all the case reports about the procedure were positive. That's encouraging," said psychiatrist Robert N. McLay, MD, PhD, who oversees studies specific to treatment for PTSD in the department of mental health at Naval Medical Center. "But the plural of 'anecdote' is not 'science.' We also found there were no formal studies testing SGB for PTSD. Clearly, those will be needed in the future."

If larger patient samples show SGB as an effective treatment for PTSD, the injection could have huge social and economic ramifications for the United States, according to a Becker's Spine Review report. The results of a RAND study suggest traditional PTSD treatment (therapy and medication) costs $6,000-$20,000 per veteran experiencing symptoms. Another book by an economics Nobel laureate suggests disability payment for veterans of the Iraq and Afghanistan conflicts could be close to $600 billion over the next 20 years without a significant change in treatment pathways.


SGB injections cost $2,000 to $3,000 per patient, which is far less than the costs currently associated with treating PTSD via standard therapies. Additionally, PTSD patients who received SGB are able to return to work and maintain a more economically productive lifestyle than they were living prior to the injection. Both of these factors could have a major impact on healthcare spending and quality of life for military veterans and other people suffering from PTSD.

"The large scale of human suffering and financial costs associated with persistent PTSD requires that we continue to search for additional treatment options," said U.S. Navy Captain and Head of Pain Management in the Department of Anesthesiology at Naval Hospital in Okinawa Anita Hickey, MD, co-author of the study. "SGB offers a promising, novel and safe approach for the treatment of PTSD without the risks and side-effects associated with medications. Being a common pain management procedure, SGB is in a position to be studied widely and more rigorously to discern which patients might benefit from this treatment.


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