We are proud to offer Stellate Ganglion Block (SGB) therapy for people diagnosed with Post Traumatic Stress Disorder (PTSD). Board Certified pain-management physician Dr. Jason Attaman performs this medical treatment for PTSD. Unlike many psychotherapy-based approaches to overcoming PTSD, stellate ganglion block is purely a medical procedure. It is fast-acting and only requires one or two visits to the clinic.
We offer a substantial discount to US Military veterans, active-duty personnel, and law enforcement. (Many of our patients come from nearby Joint Base Lewis-McChord.)
Contact us today to schedule an appointment at our Bellevue or Seattle office, or read on to find out more about stellate ganglion block as a possible treatment option for PTSD.
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. By no means is PTSD limited to military members, 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 brave patients who share their stories as well as the two pioneers in the use of SGB for PTSD; Sean Mulvaney, MD and Eugene Lipov, 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). We 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 always 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 first perform SGB 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. If you are visiting us from far away, we will typically schedule a right SGB followed by a left SGB on a subsequent day to ensure that you have the best opportunity for optimal outcomes. For safety reasons, we do not treat both sides on the same day. In our clinic, we have top of the line ultrasound machines and flouroscopy available. With rare exception, we prefer to perform this procedure under ultrasound guidance.
This video from Drs. Escolar and Amador 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 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
Dr. Attaman has performed SGB procedures for over 12 years for various conditions including PTSD. He is a Seattle Met “Top Doc” in Pain Medicine for 2015-2021 and Seattle Magazine “Top Doc” in Pain Medicine for 2019.
Take Home Message
PTSD is a life altering problem for anyone who has suffered a major traumatic event in their lives. PTSD is not limited to military experience. 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 qualified physician. If you have PTSD and feel that you are stuck, or that you have worked very hard in therapy but have reached a plateau that you cannot pass, or feel the physical symptoms of PTSD such as tension, difficulty taking a deep breath, or racing heart will not improve, SGB may be a very good option for you. It is also important to know these injections are just one component of the treatment regimen and that continued therapy under the direction of a mental health care professional is beneficial as well.