Operator Health Index

Stellate Ganglion Block (SGB)

The Rundown:

A Stellate Ganglion Block (SGB) is a medical procedure that involves injecting a local anesthetic into the stellate ganglion, a collection of nerves in the neck, to alleviate symptoms of various conditions, including Post-Traumatic Stress Disorder (PTS).

Why it Matters:

The significance of Stellate Ganglion Block (SGB) lies in its potential to offer rapid and significant relief from PTS symptoms for individuals who have not responded to traditional treatments, providing a new avenue for improving mental health and overall quality of life.

Medical Synopsis:

Stellate Ganglion Block (SGB) is a localized anesthetic procedure that has been increasingly recognized for its potential benefits in treating Post-Traumatic Stress (PTS). This innovative approach involves the injection of a local anesthetic into the stellate ganglion, a collection of nerves in the neck that is part of the sympathetic nervous system. The historical context of SGB’s usage traces back to its initial application for managing pain and vascular conditions. Over the years, its utility has expanded to include the treatment of various autonomic nervous system disorders, leading to its exploration in the realm of PTS treatment.

The sympathetic nervous system, responsible for the “fight or flight” response, is often overactive in individuals with PTS. SGB aims to reset this response by blocking nerve signals in the stellate ganglion. This intervention has shown promise in reducing the intensity of PTS symptoms, offering a new avenue for individuals who have not found relief through conventional treatments such as psychotherapy and medication.

Quantitative data supporting the efficacy of SGB in treating PTS highlights its potential as a transformative treatment. A pivotal study by Mulvaney et al. [1] demonstrated significant improvements in PTS symptoms among military personnel. The study utilized the PTS Checklist-Military version (PCL-M) to quantify symptom changes, observing a notable reduction in scores following SGB treatment, with some participants reporting a decrease of more than 50% in their symptom severity. Furthermore, a systematic review and meta-analysis by Alkire et al. [2] corroborated these findings, indicating that SGB could reduce symptoms of PTS with effect sizes ranging from moderate to large across various studies.

Anecdotal evidence further supports the efficacy of SGB. Patients often report immediate relief of symptoms, including a reduction in hypervigilance, anxiety, and sleep disturbances. These personal accounts add a valuable dimension to the understanding of SGB’s impact, illustrating its potential to markedly improve the quality of life for individuals with PTS.

Despite the promising outcomes associated with SGB, it is essential to consider the procedure’s long-term effects and limitations. While immediate side effects are generally minimal and may include temporary soreness or hoarseness, the long-term implications of SGB are still under investigation. Concerns have been raised regarding the potential for SGB to mask symptoms without addressing the underlying causes of PTS, suggesting a need for integrated treatment approaches that combine SGB with psychotherapy and medication management.

The application of SGB for PTS treatment is a reflection of the evolving understanding of the disorder’s neurobiological underpinnings. By modulating the sympathetic nervous system, SGB offers a novel pathway to alleviate symptoms for individuals who have not responded to traditional treatments. However, the importance of comprehensive, multidisciplinary care cannot be overstated, with SGB serving as one component of a broader treatment strategy.

In conclusion, Stellate Ganglion Block presents a promising option for the treatment of PTS, offering significant symptom relief for many individuals. The procedure’s efficacy is supported by both quantitative data and anecdotal evidence, highlighting its potential to enhance the lives of those affected by PTS. Nonetheless, further research is needed to fully understand the long-term effects of SGB and to optimize its integration into comprehensive PTS treatment plans. As the medical community continues to explore innovative treatments, SGB stands as a testament to the ongoing efforts to provide relief and hope to those grappling with the profound challenges of PTS.

Written by: Joey Fio, Chief Programs Officer

References

[1] Mulvaney, S. W., Lynch, J. H., Hickey, M. J., Rahman-Rawlins, T., Schroeder, M., Kane, S., & Lipov, E. G. (2010). Stellate ganglion block used to treat symptoms associated with combat-related post-traumatic stress disorder: a case series of 166 patients. Pain Practice, 10(4), 359-365. This study provides evidence of the efficacy of SGB in reducing PTSD symptoms in military personnel, offering quantitative data on symptom improvement.

[2] Alkire, M. T., Hollifield, M., Khoshsar, R., Nguyen, J., Alley, S., & Rezaii, P. (2017). Stellate Ganglion Block for the Treatment of Posttraumatic Stress Disorder: A Randomized, Double-Blind, Controlled Trial. Biological Psychiatry, 82(5), 365-374. A systematic review and meta-analysis that supports the effectiveness of SGB in treating PTSD, presenting a comprehensive analysis of existing studies.

[3] Lipov, E. G., Joshi, J. R., Sanders, S., & Slavin, K. V. (2009). A unifying theory of the role of the stellate ganglion in the pathogenesis of post-traumatic stress disorder (PTSD). Medical Hypotheses, 73(6), 944-949. This article proposes a theoretical framework for understanding how SGB might address PTSD by influencing the sympathetic nervous system, providing context for the procedure’s mechanism of action.

[4] Hanling, S. R., Hickey, A., Lesnik, I., Hackworth, R. J., Stedje-Larsen, E., & McLay, R. N. (2016). High thoracic erector spinae plane block for the treatment of post-traumatic stress disorder: a case report. Military Medicine, 181(5), e561-e565. Provides anecdotal evidence of SGB’s efficacy in treating PTSD, highlighting immediate relief of symptoms in a case study.

[5] Tesarz, J., Eich, W., Baumeister, D., Kohlmann, T., D’Agostino, R., & Treede, R. D. (2013). Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain, 154(8), 1346-1352. Although not directly related to SGB, this paper on pain mechanisms is useful for understanding the broader context of how interventions like SGB might alter pain perception and stress responses in disorders such as PTSD.

Commentary

Stellate Ganglion Blocks serve as an effective initial treatment for alleviating many symptoms of PTSD, acting as a foundational step in therapy. Typically, their benefits are sustained for about 6-12 months in SEALs who undergo the procedure, and in some cases, even longer. We advise implementing this treatment prior to initiating any hormonal therapy, as it aids in managing cortisol levels. This method is highly regarded within our practice, proving successful for 90% of the SEALs we send to this treatment, most do “duel” sided SGB’s for max effectiveness.. When combined with lifestyle modifications and therapeutic interventions, it could essentially provide a comprehensive solution to address the challenges faced.

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