Post-traumatic Stress Disorder (PTSD)
At the Urban Pain Institute, we are pursuing a novel treatment option for patients with Post-traumatic Stress Disorder (PTSD).
PTSD is a pressing social, health, lifestyle, and economic issue for the general public, especially for our active duty military personnel and our veterans. The National Comorbidity Survey Replication estimates lifetime prevalence of PTSD to be 6.8% 1, and in Operation Enduring Freedom and Operation Iraqi Freedom service members, this prevalence was 13.8% 2. Upon return to civilian life, PTSD can cause social impairment and withdrawal, including difficulty maintaining a job, erosion of familial relationships, and depression. Physiologically, PTSD is strongly linked to health problems including cardiovascular and pulmonary diseases, substance abuse, early mortality, and high rates of suicide 2,3. Between 2004 and 2009, the Veterans Health Administration spent $1.4 billion on the treatment of PTSD in deployed veterans 3. Conventional treatment with pharmacotherapy and cognitive processing therapy results in slow response, incomplete resolution, and a high failure rate for moderate to severe refractory PTSD 4.
We are treating patients with diagnosed moderate to severe PTSD who have not responded well to psychotherapy (behavioral) or pharmacotherapy (medication) with a procedure called stellate ganglion block (SGB). It is a minimally-invasive procedure that is widely used in interventional pain management for issues such as reflex sympathetic dystrophy, sympathetic maintained pain, or complex regional pain syndrome. SGB involves injecting a local anesthetic into the lower and middle cervical ganglia, effecting sympathetic blockade to the neck, upper extremity, upper thorax, and cranium through fibers that pass along the carotid artery. It has been safely and successfully performed for decades, with an extremely low risk of complications. Research has shown that his procedure may also be effective for a condition other than pain: PTSD. Since 2008, this procedure has been used in hundreds of PTSD cases all over the country with positive results. While this is a fairly novel approach for the treatment of PTSD, there is already evidence for its effectiveness, and individuals report significant relief and satisfaction 4, 5, 6, 7, 8, 9.
Urban Pain Institute’s treatment protocol consists of a series of 3 SGB’s, each 3-4 weeks apart, with follow-up visits in between to monitor progress. The procedure is performed in our state-of-the-art in-house procedural suite by our highly skilled interventional pain physician, who is double-board certified in anesthesiology and pain management.
Patients are first given a mild sedative though an IV for comfort. An injection site in the neck is numbed with a local anesthetic and a small needle is directed towards the sympathetic nerves of the stellate ganglion at the C6 level. To ensure accurate placement of the needle, the procedure is performed using the highest standards, including ultrasound and fluoroscopic guidance.
In addition to receiving treatment for your PTSD, you may be eligible to participate in our research project. We have teamed up with leading research scientists to study the mechanism behind using SGB for PTSD. Published research already tells us that this procedure does work, but we are still trying to uncover what is occurring in the body that makes this procedure so effective for this condition.
Participation is optional and you may choose to opt out at any time, and your information will always be kept confidential.
If you are interested in participating in this exciting research opportunity, call us today at (907) 277-7246!
For more information on PTSD, please visit these great informational websites:
- Veteran’s Administration (VA) (hyperlink ptsd.va.gov/)
- National Institute of Mental Health (NIMH) (hyperlink http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml)
References
- Kessler, RC, Berglund, P, Delmer, O, Jin, R, Merikangas, KR, & Walters, EE. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
- Tanielian, T. & Jaycox, L. (Eds). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation.
- Congressional Budget Office. (2012). The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans.
- Navaie M, Keefe MS, Hickey AH, McLay RN, Ritchie EC, et al. (2014) Use of Stellate Ganglion Block for Refractory Post-Traumatic Stress Disorder: A Review of Published Cases. J Anesth Clin Res 5: 403. doi:10.4172/2155-6148.1000403
- Hickey, A., Hanling, S., Penvey, E., Allen, R., McLay, R.N. (2012). Stellate ganglion block for PTSD. Am J Psychiatry 169(7), 760. doi: 10.1176/appi/ajp.2012.11111729.
- Lipov, E.G., Navaie, M., Brown, P.R., Hickey, A.H., Stedje-Larsen, E.T., et al. (2012) A novel application of Stellate Ganglion Block: preliminary observations for the treatment of Post-traumatic stress disorder. Mil Med 177(2): 125.
- Alino, J., Kotsaka, D., McLean, B., Hirsch, K. (2013). Efficacy of stellate ganglion block in the treatment of anxiety symptoms from combat-related post-traumatic stress disorder: a case series. Mil Med 178(4), e473-476.
- Mulvaney, S., Lynch, J.H., Hickey, M.J., Rahman-Rawlins, T. Schroeder, M., et al. (2014). Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Military Medicine, 179(10), 1133-1140.
- McLean, B. (2015). Safety and patient acceptability of stellate ganglion blockade as a treatment adjunct for combat-related post-traumatic stress disorder. Cureus, 7(9), e320. doi: 10.7759/cureus.320.
