Using Stellate Ganglion Block (SGB) to Treat Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder 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. Overall SGB success rates have averaged 70-75% over the first nine years of use. In collaboration with neuroscientists and clinical observations, modifying the SGB procedure, have resulted in current success rates in the 85 to 90% range.
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. Reappearance of symptoms can occur if other trauma(s) are inflicted after SGB, if the patient is genetically predisposed to be sensitive to stress. 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.
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.