By: Derek Welch
Posttraumatic stress disorder (PTSD) is a complex mental health condition that can arise after experiencing or witnessing a life-threatening event such as a natural disaster, military combat, or violent assault. Epidemiological studies reveal that PTSD affects about 3.5% of adults in the U.S. annually, with women twice as likely to be affected as men1. The lifetime prevalence varies from 1.3% to 12.2% worldwide2. Factors contributing to PTSD include exposure to trauma, lack of social and familial support, individual susceptibility including genetic predisposition, prior history of mental health conditions, and the severity and duration of the traumatic event3.
Traditional treatments for PTSD typically include psychotherapy, cognitive-behavioral therapy (CBT), and medications like Selective Serotonin Reuptake Inhibitors (SSRIs). These approaches aim to reduce symptoms by helping the individual process the trauma, develop coping strategies, and restore a sense of control4. Eye Movement Desensitization and Reprocessing (EMDR) is a specialized form of therapy that utilizes bilateral stimulation to help process distressing memories5. Recently, ketamine, an NMDA receptor antagonist, has emerged as a potential therapy for PTSD, with early research showing promising results in rapidly reducing symptoms, though further studies are required to establish long-term efficacy6.
Stellate ganglion block (SGB) is a procedure where a local anesthetic is injected into a cluster of nerves located between the C6 and C7 vertebrae. This technique has been used for pain management for nearly a century and has recently been employed to treat posttraumatic stress disorder (PTSD). A significant reduction in Generalized Anxiety Disorder questionnaire (GAD-7) scores has been observed following SGB treatment, with 79.6% of patients demonstrating clinically meaningful improvement within a week7. SGB has been shown to reduce Clinician-Administered PTSD Scale for DSM-5 total symptom severity scores over 8 weeks compared with sham treatment8.
Moreover, SGB is recognized as a fast-acting treatment. The rapid effect of SGB, with symptomatic improvements observed within minutes to days post-procedure, is an attribute that distinguishes it from other treatments9. By presenting a biological approach to mental health, SGB may also contribute to destigmatizing mental health treatments9. Its nature, not requiring continuous daily or weekly administration, could further enhance patient adherence to the treatment protocol10.
However, there are risks and considerations that must be addressed. The exact means by which SGB alleviates PTSD symptoms is not fully understood11. While promising, the information underscores the necessity for more substantial, well-powered, randomized, sham-controlled trials to fully understand the short-term efficacy, durability of effects, and safety of the treatment. SGB is also generally promoted as an adjunct therapy for those unresponsive to conventional treatments, emphasizing the necessity of patient-specific assessment and an individualized approach11.
In conclusion, stellate ganglion block appears to be an encouraging approach for the treatment of PTSD, showing substantial benefits in reducing anxiety and PTSD symptoms. However, further research is required to elucidate the mechanism, evaluate the long-term efficacy, and fully understand potential risks. This promising treatment must be approached with careful consideration and individualized assessment.
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