Stellate Ganglion Block (SGB) for Post Traumatic Stress Disorder (PTSD) in Seattle and Bellevue
What is PTSD?
Post-Traumatic Stress Syndrome (PTSD) is a disorder characterized by a heightened response to a traumatic event. This can result in feelings of persistent stress, anxiety, and fear, even when there is no immediate danger present. Those who suffer from PTSD often avoid situations that remind them of the traumatic event or place and may experience flashbacks. Military members who have seen combat are at risk for developing PTSD and this disorder can be difficult to treat and may even prevent them from living a normal life. However, PTSD can develop from any type of traumatic experience, either physical or emotional. It is often treated with various forms of therapy, medication, and at times, stellate ganglion block (SGB) injections. SGB for PTSD has recently gained worldwide attention due to the TV program “60 Minutes.”
In the Media
Click the “play” button to watch three recent broadcasts about SGB for PTSD from “60 Minutes” and “CBS This Morning” and “The Joe Rogan Experience.” These videos feature the two pioneers in the use of SGB for PTSD, Eugene Lipov, MD and Sean Mulvaney, MD.
What is a Stellate Ganglion Block (SGB)?
The stellate ganglion is a bundle of nerves that is located deep in the lower neck. It is located within the cervical sympathetic chain. Sympathetic nerves play a strong role in our fight-or-flight response. Injecting local anesthetic (numbing medicine) around these nerves is called a stellate ganglion block (SGB). SGB can help reset these nerves that are thought to be chronically in fight-or-flight response. Stellate ganglion block (SGB) injections need to be performed under either ultrasound and/or fluoroscopic guidance as there are major blood vessels and organs nearby. The SGB injection is not new and has been used for decades to treat conditions such as chronic regional pain syndrome (CRPS) of the upper extremity. More recently, SGB is being used to treat PTSD.
The only physicians that are formally trained in the SGB procedure are Interventional Pain Management physicians (MDs and DOs). Physicians such as myself and Dr. Attaman learn how to safely perform SGB during a year-long advanced training program called a Pain Medicine fellowship. A fellowship is the highest level of training a physician can complete and is done after four years of medical school, one year of internship, and three years of residency. Stellate ganglion block is a technically demanding procedure that requires precise image guidance using an ultrasound machine and sometimes a form of x-ray called a fluoroscope. We generally prefer to use ultrasound as it allows us to better visualize nerves, arteries and veins in this delicate area.
Be careful, you may find professionals such as naturopathic physicians (NDs) or nurse practitioners (ARNPs or DNPs) offering this procedure. They are unqualified to perform this procedure. They will do their best to hide their lack of training in interventional pain management procedures from you. These professionals complete no formal hospital-based residency nor fellowship in performing pain management procedures. It is dangerous for NDs or NPs to attempt to perform delicate interventional procedures such as a stellate ganglion block. If you are looking for a professional to perform this procedure on you, but sure they are a physician (MD or DO) and have completed medical school, internship, formal residency and especially a one year long accredited Pain Medicine fellowship. You can check if your physician is a board certified Pain Medicine physician at the American Board of Medical Specialties or American Osteopathic Board of Anesthesiology websites. Only then are they qualified to safely perform this procedure.
You may wonder why some physicians use ultrasound while others use fluoroscopy. The answer is fairly simple; it is much safer and accurate to use ultrasound but much more difficult to learn this method. Fluoroscopy is faster but does not allow for the visualization of delicate nerves and blood vessels in the area. The procedure is non painful, as it involves only a single needle poke in the side of the neck after numbing the skin. Typically, we will perform SGB only on the right side of your neck, as medical studies have found the right side to be most efficacious in most people. However, less than 5% of patients may require an SGB on the left side of the neck if they do not respond to a properly performed right sided SGB procedure. In our clinic, we have top of the line fluoroscopy and ultrasound available. With rare exception, we prefer to perform this procedure under ultrasound guidance.
This video demonstrates the anatomy and technique involved with this specialized procedure:
Several studies have been performed in the past, analyzing the effectiveness of stellate ganglion block (SGB) for the treatment of PTSD. Although some results were favorable, the level of research was not ideal. Very recently, however, the first multi-site, randomized control trial was published the Journal of the American Medical Association (JAMA). The results suggest that two stellate ganglion blocks two weeks apart can help reduce symptoms related to PTSD. You may read the study here:
Our SGB Experience
During my active-duty service as a Major in the Air Force as a pain specialist and anesthesiologist, I treated active duty members and veterans who suffered from PTSD. While on tour in Afghanistan, I worked alongside those who had served multiple tours in combat zones and saw the negative impact PTSD can have. I was fortunate to perform stellate ganglion blocks on our soldiers and saw first-hand the positive effect it had on their mental health. Now that I’m a veteran myself, it’s my hope that I can continue to perform procedures such as this that can help those with PTSD improve their quality of life.
Dr. Attaman has performed SGB procedures for over 11 years for various conditions including PTSD. He is a Seattle Met “Top Doc” in Pain Medicine for 2015-2020 and Seattle Magazine “Top Doc” in Pain Medicine for 2019. He is very enthusiastic about the recent advances in the medical literature on the use of SGB for PTSD.
Dr. Attaman and myself are working together to help patients with the SGB treatment.
Take Home Message
PTSD is a potentially debilitating problem for anyone who has suffered a major traumatic event in their lives, not just military members. Stellate ganglion blocks have shown promising results in recent studies and those who suffer from PTSD are encouraged to discuss the SGB procedure with a highly-trained physician. It is also important to know these injections are just one component of the treatment regimen and that continued therapy and medications under the direction of a mental health care professional are needed as well.