Stellate Ganglion Block Injections to Combat PTSD?

Stellate Ganglion Block Injections to Combat PTSD? - PMIR

Post-traumatic stress disorder is commonly associated with wartime horror, yet it’s a condition that affects not only those touched by combat, but also civilians struck by grief, assault, domestic violence, and other traumatic experiences. Current treatments for PTSD largely involve the use of psychotherapy and medication, but experimental treatments have proven promising as well, including research done on the effectiveness of stellate ganglion blocks in combatting the symptoms of PTSD.

To understand why a nerve block might help in the treatment of PTSD, it’s important to distinguish PTSD from the more common effects of any given traumatic event. While traumatic events are sure to leave a lasting impact on those who survive them, that impact is wholly subjective. PTSD in particular is not a given in any tragedy, but a rare disorder developed by an exceptionally powerful traumatic experience. PTSD haunts people, leaving them to struggle with symptoms that complicate even the simplest of tasks.

But there’s more to PTSD than the circumstances that trigger it. The effects of traumatic stress on the brain are well-documented, with findings that show that individuals with PTSD tend to share certain neurobiological characteristics, including increased amygdala function and smaller hippocampal volumes.

Patients with PTSD also experience increased responses to stress through the release of more stress hormones, such as epinephrine and cortisol. This, in turn, affects them both physically and emotionally. A stellate ganglion block may affect how the brain reacts to stress, minimizing and even managing the symptoms of PTSD in some patients.

What Are Stellate Ganglion Blocks?

At its core, stellate ganglion blocks are an injection procedure that involves delivering an anesthetic directly into the tissue of the stellate ganglion, a nerve cluster found between the last two vertebrae of the neck. Part of the body’s sympathetic nervous system, stellate ganglion nerves supply the face and arms, and are connected to the brain’s amygdala.

Known colloquially as the lizard brain, the amygdala is a tiny two-part region within the brain responsible in part for survival instincts, emotions, libido, and more. While the evidence linking the amygdala solely to anxiety is lacking – an overactive amygdala alone isn’t the primary culprit in anxiety disorders, such as PTSD – the stellate ganglion block aims to help reduce the symptoms of PTSD primarily by targeting the amygdala from a far more accessible spot in the body.

First designed and utilized in the early 20th century, the stellate ganglion block is generally utilized to treat chronic pain in the upper extremities, including conditions such as Raynaud’s phenomenon, and complex regional pain syndrome, as well as phantom pains and shingles.

Its psychiatric potential was first explored in 1945, when an American clinic utilized the stellate ganglion block as an experimental treatment for depression.

It was the Finnish who first utilized the block to treat PTSD in 1998. While the treatment aimed to treat the patient’s excessive hand sweating (a function of the body controlled through the sympathetic nervous system), a side effect of the treatment was reported relief from symptoms of PTSD.

Since then, stellate ganglion blocks have been administered in the treatment of PTSD several thousand times, particularly in the US Army.

The findings are promising, but not conclusive.

How Is PTSD Currently Treated?

It’s important to keep in mind that PTSD is currently being treated through a combination of therapy and medication, with a major focus on therapy. Current first line treatments for PTSD are not massively successful, however, only eliciting an estimated 30 to 40 percent success rate (where success is defined as definitive remission of symptoms).

Therapies utilized in the treatment of PTSD include cognitive processing therapy, prolonged exposure therapy, and eye movement desensitization and reprocessing. These therapies are largely designed to help patients confront the thoughts and circumstances that trigger their panic and anxiety, through calm, step-by-step intervention.

The role that pharmacology should play in the treatment of PTSD is much more controversial. When prescribed, the most common drugs utilized to treat PTSD are paroxetine and sertraline, two types of SSRI antidepressants. Some doctors prescribe off label medication, including various types of antidepressants, as well as antipsychotics and beta-blockers.

What Research Says

This all goes to say that PTSD is currently being combatted with a series of different treatments, yet their efficacy largely varies.

Alternative treatments are thus of great interest to both the US military, as well as millions of Americans who struggle with PTSD as a result of non-combat experiences. As such, the research shows that stellate ganglion blocks can be effective yet are not always applicable.

Lack of proper documentation, follow-up, and peer reviews means that much of the research surrounding the efficacy and risk of stellate ganglion blocks for PTSD treatment is not completely trustworthy or valid. The first randomized and controlled study on the efficacy of SGB was conducted in 2016, which showed modest improvements over sham (placebo) treatments. However, one properly conducted study is not enough evidence to declare the treatment ineffective or argue that previous research is more applicable. The simple truth is that SGB has had mixed results so far, and more research is needed.

Even when effective, SGB alone simply reduces the symptoms of the patient’s PTSD, but it does not eliminate them. There is no cure for PTSD. Instead, the disorder must be managed, its symptoms mitigated. SGB can help patients respond to other therapies and effectively combat their anxiety.

How Is a Stellate Ganglion Block Injection Performed?

As a nerve block, a stellate ganglion block involves injecting an anesthetic directly into the tissue surrounding the nerve, thereby indirectly affecting the brain and reducing the release of norepinephrine and other stress hormones. The procedure starts by preparing the patient for a simple series of injections in the neck. Patients will be instructed to prepare themselves accordingly, usually by refraining from drinking or eating for several hours before the procedure.

Once in the clinic, the first step is to either sedate the patient or apply a local anesthetic to the neck. The first injection after the sedation will be to send a special ink into the tissue around the vertebrae, so x-ray imaging can help guide the next needle into the tissue near the stellate ganglion.

Once in position, a strong anesthetic is injected into the region. The patient is kept for observation for a few hours, and complications are rare. Other side effects may include hoarseness of the voice, mild drooping facial muscles, and red eyes.

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