Stellate Ganglion Block: A New Treatment for PTSD

Randomized, controlled trial demonstrates effectiveness of a procedure that helps relieve symptoms of posttraumatic stress disorder

More than 7 million adults throughout the United States suffer from posttraumatic stress disorder (PTSD). Most commonly thought of as being associated with military combat, PTSD can occur following any traumatic event—including natural disasters, terrorist incidents, serious accidents, or physical or sexual assault. The disorder is often compounded by depression and substance abuse. Those who suffer from PTSD can also experience interpersonal and relationship difficulties as well as problems at work.

The U.S. Department of Veterans Affairs estimates that PTSD affects or has affected as much as 20 percent of those who served in the Vietnam War, Desert Storm, and Operations Iraqi Freedom and Enduring Freedom. Recent evidence suggests that PTSD is increasing among service members—rising from 7 percent in 2005 to 11 percent in 2008.

The Search for Effective Therapies for PTSD

The ideal PTSD treatment—safe, effective, and fast-acting, with few side effects—has been elusive. And as with many mental health issues, individuals with PTSD sometimes have trouble accepting or adhering to some of the options that are available. The Department of Defense and healthcare researchers have pursued a variety of solutions for years.

In the early 2010s, some military medical centers began offering patients with PTSD a procedure that had been used for decades to relieve pain. The procedure, called stellate ganglion block, or SGB, involves injecting a local anesthetic into the stellate ganglion—a group of nerve cells and nerve fibers in the neck that helps regulate the body’s “fight or flight” mechanism. The procedure was traditionally done using X-ray to identify the stellate ganglion area, but today, ultrasound is the gold standard due to its greater accuracy in visualizing the structure.

As more and more individuals with PTSD tried SGB, the reports seemed promising. But the medical community still needed evidence of its effectiveness. RTI launched a randomized, controlled trial of SGB in 2014, and in fall 2019, we published our results showing that it is indeed effective in alleviating PTSD symptoms. We also found SGB appears to be an effective treatment for symptoms of generalized anxiety disorder and major depressive disorder. RTI is currently conducting three additional studies investigating the effects of SGB on other outcomes including sleep, neurocognitive functioning, and tinnitus.
 

Combining Clinical Data with Patient-Centered Perspectives

Our initial study, published in 2019, was the first multi-site randomized controlled trial of SGB for treatment of PTSD symptoms. The trial determined that the SGB procedure decreases the severity of PTSD symptoms. RTI coordinated all aspects of the study at three U.S. military hospitals. This included developing the study protocol and monitoring its execution to measure patient health outcomes for 8 weeks after treatment.

Study participants received either SGB or what’s referred to as a sham procedure (akin to a placebo), during which the participant received an injection of saline near the stellate ganglion instead of the SGB medication.

We also conducted focus groups and interviews with service members, spouses, and healthcare providers to explore how SGB is perceived in comparison to other treatments for PTSD, which should predict whether SGB could be widely accepted as an option for the many service members, veterans, and civilians who suffer from PTSD.

Expanding Treatment Options and Addressing the Stigma of PTSD

The original study ran through 2018 and gathered and analyzed clinical and qualitative data to inform recommendations for U.S. military medical centers and private practitioners who treat patients with PTSD symptoms.

SGB is a true breakthrough in PTSD treatment. It is a powerful new option for people suffering from PTSD and shows early promise for treating generalized anxiety disorder and major depressive disorder. This option may be more readily accepted by military service members and veterans, for whom the stigma associated with mental healthcare is often a deterrent to seeking treatment.

While more military and civilian providers are offering SGB as a treatment option for PTSD, it is critical to speak with qualified health professionals when seeking treatment. Specifically, physicians should be experienced in performing SGBs using ultrasound as opposed to fluoroscopy (X-ray). We hope that our research showing the promising effects of SGB on PTSD and other mental health conditions is the first step to healing for millions of service members, veterans, and others for whom PTSD symptoms have long been a barrier to a better life.