Will Physicians Be Willing to Use It? 

Millions of people with post-traumatic stress disorder (PTSD) — from veterans to rape survivors — have new hope because of a watershed study showing that the injection of an anesthetic to a bundle of nerves in the neck can relieve their symptoms in a clinically significant way. The treatment is known as the stellate ganglion block, or SGB. Used since 1925 for problems such as pain in the arm and shingles, it is safe and effective.

In the newly released, eight-week, U.S. Army-funded clinical trial of 108 active-duty service members with PTSD, the nonprofit research institute RTI International found that patients’ scores on the PTSD Checklist, used to diagnose PTSD and determine its severity, improved by an average of 12.6 points, with 10 points being clinically significant. The results were just published in JAMA Psychiatry, a peer-reviewed journal published by the American Medical Association. 

So how does an injection of an anesthetic produce changes in the brain that last for years? 

When someone suffers trauma, the brain produces more of a substance called nerve growth factor (NGF), which promotes new sympathetic nerve growth. Sympathetic nerves mobilize the body’s resources under stress. The new nerve growth, in turn, leads to the production of the neurotransmitter norepinephrine. When someone has too much norepinephrine, it makes them hyper-vigilant. 

When the SGB injection anesthetizes the bundle of nerves in the neck called the stellate ganglion, this reduces the concentration of NGF. The NGF level drops, and when it does, this leads to a pruning of the extra nerve fibers that grew because of trauma. As a result, the nervous system returns to a pre-trauma state. 

Now that this latest study has reinforced that the SGB works, the onus is on the medical profession to bring PTSD treatment up to date. As a board certified anesthesiologist, I have been using the SGB for trauma survivors since 2006 and treated more than 650 patients, with about half from the military and half from the civilian population. My team and I have seen even better results than other studies. More than 80 percent of patients have seen a significant reduction of PTSD symptoms, owing to recent modifications I have made to the SGB. A number of medical studies in the military have also supported the use of the SGB.

However, few patients with PTSD have had access the SGB to date. One reason is that many doctors have been skeptical that an injection like this could have a psychiatric effect. Other doctors haven’t heard about it. Only anesthesiologists or specially trained physicians are qualified to administer the SGB for PTSD, and some doctors don’t know it can be done. 

However, many doctors who do know about it have ignored it. I believe it hasn’t been widely adopted because some doctors, who use a drug-based approach to treating PTSD, and Big Pharma both have a vested interest in maintaining the status quo. 

Until now, the “gold standard” for treating PTSD has been using pharmaceuticals and psychological therapy. Often, the drugs come from a class of medications called selective serotonin reuptake inhibitors (SSRIs), which may reduce anxiety or arousal, or atypical antipsychotics, which may come with very serious side effects.

Unfortunately, this approach doesn’t work for many patients. Research published in JAMA shows that only 50% of veterans get PTSD treatment, and just 40% of them recover, meaning only 20% of those who need care are benefiting from it. 

Now SGB offers them new hope. The SGB has a 95% compliance rate, according to a study of military veterans.  Other research shows that 70% of patients treated with the SGB show a clinically significant reduction in symptoms.

There is a lot at stake. About 8 million adults will have PTSD symptoms in a given year, according to the National Center for PTSD. Many struggle to cope with everyday life. 

When patients develop this condition under the stress of a traumatic situation, the sympathetic nervous system, turns on the fight-or-flight response. However, with PTSD, the sympathetic nervous system gets stuck in the “on” position, and the body stays in fight-or-flight mode long past the dangerous situation and sometimes for decades. 

As a result, people with PTSD often find themselves hyper-aroused and hyper-vigilant in situations where other people feel reasonably safe, like driving a car around town or walking through a shopping mall or down a city street. 

In some patients, PTSD can lead to violence. Some of my patients have choked or punched family members who startled them in their sleep. PTSD also causes nightmares in some patients, disrupting their sleep patterns and compounding the stress. Some sufferers of PTSD feel numbness or withdraw from situations that trigger their PTSD and end up isolated, unable to maintain relationships at home or work. 

In the most severe cases, PTSD is life threatening. A number of my patients have told me they would have committed suicide if I had not accepted them for treatment with the SGB or if it didn’t work. When patients have reached that state, there is little time to waste in bringing them relief. 

Fortunately, there is now a quick and highly effective treatment available to help them. Whether they actually benefit from it will depend on whether their physicians are willing to disrupt the status quo — and put patients first. 

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