Stellate Ganglion Block for PTSD
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Post-traumatic stress disorder (PTSD) is the third most common psychiatric diagnosis among Veterans seen in the Veterans Health Administration (VHA). PTSD can be debilitating, leading to a decline in quality of life (QoL) and causing significant medical, mental health, interpersonal, and social impairment. First-line treatments for PTSD include psychotherapy, pharmacotherapy, or their combination; however, several challenges have been identified in their effectiveness and reach. Stellate ganglion block (SGB), also called cervical sympathetic block, has been promoted as an adjuvant in individuals with PTSD who have not fully responded to conventional therapies. One proposed mechanism of action is that SGB might inhibit connections between the peripheral sympathetic nerve system and regions of the cerebral cortex thought to be abnormally activated in PTSD. Some proposed benefits of SGB for PTSD include (1) it may destigmatize treatment by offering a biologic approach to PTSD management, (2) it may offer a fast-acting treatment alternative with improvements reported within minutes to days of the procedure, and (3) it may increase compliance as it does not require continuous daily or weekly administration.
The science behind itPosttraumatic Stress Disorder (PTSD) is a debilitating psychiatric condition characterized by symptoms that develop in response to being exposed to actual or threatened death, serious injury, and/or sexual violation. Those people suffering from PTSD after having survived a traumatic event continue to live as though the terror of the past is still ever present in their life today. Additionally, PTSD is almost never the only disorder afflicting a person. It is quite common, if not the norm, for individuals with PTSD to develop co-occurring psychiatric conditions, such as Major Depressive Disorder, an anxiety disorder, and/or a substance abuse problem. Furthermore, PTSD and its related sequalae are often chronic disorders that can prove to be difficult to ameliorate. This has been especially true in active duty military and veteran populations, where some of the most effective treatments for PTSD (e.g. prolonged exposure therapy and cognitive processing therapy) are typically less effective with combat related traumas. The search for ways to heal from traumatic experiences continues, and is just as relevant, if not more so today, as it was when our service members from the Vietnam war advocated for the creation of the PTSD diagnosis almost 40 years ago.
This leads us to the recent news reports involving the Department of Defense's two million dollar investment in researching the efficacy of stellate ganglion block (SGB) injections as a possible effective treatment for PTSD. While there is always reason to be excited by the possibility of a treatment that is as simple as receiving one injection, there is also reason to be weary and cautious. When something sounds too good to be true I immediately start to wonder if it is too good to be true. Let's look at what SGB is and what we currently know about it.
Briefly, and oversimplifying the treatment, the idea behind SGB injections is to introduce an anesthetic into the stellate ganglion – a block of nerves that sit near the base of the neck. The anesthetic is hypothesized to block this bundle of nerves from erroneously passing along messages from the parasympathetic nervous system to the central nervous system about the need for initiating the "flight or flight" response. Because people with PTSD have survived a life threatening event, they are predisposed to inaccurately perceiving threat and danger in their environment. This injection is supposed to help prevent their body from following through on activating biological systems that aren't actually needed. This is important because it is when the body responds to the perceived danger it reinforces the person's belief that what they perceived was in fact true – otherwise why would their body be responding in a way that is so similar to how it felt when the original trauma they survived occurred? When the body does not respond in a similar way it helps a person to challenge the inaccuracy of their initial perception and over time helps an individual better perceive the risks of the world around them. The question for the Department of Defense is if this injection actually works.
Sere Videos Below...
Post-traumatic stress disorder (PTSD) is the third most common psychiatric diagnosis among Veterans seen in the Veterans Health Administration (VHA). PTSD can be debilitating, leading to a decline in quality of life (QoL) and causing significant medical, mental health, interpersonal, and social impairment. First-line treatments for PTSD include psychotherapy, pharmacotherapy, or their combination; however, several challenges have been identified in their effectiveness and reach. Stellate ganglion block (SGB), also called cervical sympathetic block, has been promoted as an adjuvant in individuals with PTSD who have not fully responded to conventional therapies. One proposed mechanism of action is that SGB might inhibit connections between the peripheral sympathetic nerve system and regions of the cerebral cortex thought to be abnormally activated in PTSD. Some proposed benefits of SGB for PTSD include (1) it may destigmatize treatment by offering a biologic approach to PTSD management, (2) it may offer a fast-acting treatment alternative with improvements reported within minutes to days of the procedure, and (3) it may increase compliance as it does not require continuous daily or weekly administration.
The science behind itPosttraumatic Stress Disorder (PTSD) is a debilitating psychiatric condition characterized by symptoms that develop in response to being exposed to actual or threatened death, serious injury, and/or sexual violation. Those people suffering from PTSD after having survived a traumatic event continue to live as though the terror of the past is still ever present in their life today. Additionally, PTSD is almost never the only disorder afflicting a person. It is quite common, if not the norm, for individuals with PTSD to develop co-occurring psychiatric conditions, such as Major Depressive Disorder, an anxiety disorder, and/or a substance abuse problem. Furthermore, PTSD and its related sequalae are often chronic disorders that can prove to be difficult to ameliorate. This has been especially true in active duty military and veteran populations, where some of the most effective treatments for PTSD (e.g. prolonged exposure therapy and cognitive processing therapy) are typically less effective with combat related traumas. The search for ways to heal from traumatic experiences continues, and is just as relevant, if not more so today, as it was when our service members from the Vietnam war advocated for the creation of the PTSD diagnosis almost 40 years ago.
This leads us to the recent news reports involving the Department of Defense's two million dollar investment in researching the efficacy of stellate ganglion block (SGB) injections as a possible effective treatment for PTSD. While there is always reason to be excited by the possibility of a treatment that is as simple as receiving one injection, there is also reason to be weary and cautious. When something sounds too good to be true I immediately start to wonder if it is too good to be true. Let's look at what SGB is and what we currently know about it.
Briefly, and oversimplifying the treatment, the idea behind SGB injections is to introduce an anesthetic into the stellate ganglion – a block of nerves that sit near the base of the neck. The anesthetic is hypothesized to block this bundle of nerves from erroneously passing along messages from the parasympathetic nervous system to the central nervous system about the need for initiating the "flight or flight" response. Because people with PTSD have survived a life threatening event, they are predisposed to inaccurately perceiving threat and danger in their environment. This injection is supposed to help prevent their body from following through on activating biological systems that aren't actually needed. This is important because it is when the body responds to the perceived danger it reinforces the person's belief that what they perceived was in fact true – otherwise why would their body be responding in a way that is so similar to how it felt when the original trauma they survived occurred? When the body does not respond in a similar way it helps a person to challenge the inaccuracy of their initial perception and over time helps an individual better perceive the risks of the world around them. The question for the Department of Defense is if this injection actually works.