One of the biggest challenges most of us veterans face when going through therapy, is the emotional and physical response our brains and bodies go through as our therapist begins to help us process our PTSD. When a person is recounting a memory of an incident, the brain is reliving that situation. In many cases, the brain is dumping adrenaline and other fight or flight hormones into the body just as it did when the situation first happened. Once this occurs, it becomes incredibly difficult for the person to be able to rationally process the situation. Their body and mind are in fight or flight mode.
This begs a question: If the patient is now in a fight or flight mode, how does the therapist deescalate that to help the patient move forward with processing the incident? Perhaps the simplest way to deal with this situation is to find a way to block the brain from triggering the fight or flight dump of hormones. The most common way to interfere with the brain, is to sedate it. However, SSRI drugs like Lexapro or Celexa and Benzodiazepines like Xanax have their own side effects, and like any other drug, they eventually wear off.
That was how I initially began to treat my PTSD- medications. I hated going down the pharmaceutical route, as these kinds of drugs make it hard for a person to hold a job or maintain a high level of cognitive thinking required by most employers. It leaves you feeling distant and emotionally detached from the world and your friends and family. Then I heard about an alternate treatment called a Stellate Ganglion Block or SGB.
I first learned about this treatment when I saw a 60-minutes episode with Medal of Honor recipient Dakota Meyer who document his experience with this procedure. Ironically, this is an older procedure that has been used for decades to treat chronic pain. More recently, it has been repurposed into a proven breakthrough treatment for veterans, active-duty service members, and civilians who suffer from Post-Traumatic Stress Disorder (PTSD). The procedure is called Stellate Ganglion Block (SGB), also known as Cervical Sympathetic Block.
According to the U.S. Department of Veterans Affairs, roughly 8 million Americans suffer from PTSD during a given year. This is an extraordinary number of people who struggle with this. In the military, PTSD has varied among service era and times of conflict. As a whole, about 11-20% of veterans are diagnosed with PTSD in a given year. An estimated 30% of Vietnam Veterans have experienced PTSD in their lifetime.
As we know, Post-Traumatic Stress Disorder is a mental health condition triggered by either experiencing or witnessing a traumatic event, such as war, disaster, accident, or abuse. Symptoms may include flashbacks, nightmares, severe anxiety, extreme physical reactions, or intense emotional distress when reminded of the trauma.
So What is SGB and How Does it Work?
I have personally had five of these treatments myself. So I will do my best to describe the procedure, what it felt like when it was being done, and what I felt like after it had been completed. To start with, the Stellate Ganglion Block is an outpatient procedure that takes less than 2 minutes from start to finish. When I had my treatment, they had me lay down on an examination table with my shirt off. They used an iodine solution to clean the neck area, then they placed a medical covering over the area. The doctor uses image-guidance techniques (such as an ultrasound) to inject a contrast solution so she can identify the specific nerve she wants to block. Once this has been identified, she injects a local anesthetic into the stellate ganglion, a cluster of nerves located between the C6 and C7 vertebrae.
When I did this injection, I felt a slight burning or tingling feeling for just a moment. It did hurt at first, but in a fraction of a second, it goes away. As the doctor uses more of the local anesthetic, it almost feels like that side of the neck and shoulder start to get real heavy. The ironic thing about the Stellate Ganglion cluster of nerves is they help control the body’s “fight or flight” response. When something triggers you, this cluster of nerves kicks this reaction into high gear and can lead to surges of anger, irritability, panic attacks, and sleep troubles. The injection blocks the nerve impulses between the brain and the body, calming this involuntary heightened reaction found in PTSD patients. It can result in a more natural “fight or flight” response and a restored sense of calm and safety.
According to a VA Fact Sheet on SGB, the treatment “has limited side effects and is relatively safe when administered by a trained clinician.” Some of the side effects may include a drooping eyelid, red eye, hoarse throat or feeling like there is a lump in the back of the throat.
As someone who has had five of these injections, I only experienced a drooping eyelid, and feeling like there was a lump in the back of my throat. The effects wore off within a couple of hours. I typically just took a nap after the procedure for a couple hours. By the following day, I had no side effects at all. Within seconds of the procedure being done, it really did feel like everything just calmed down. My mind was no longer racing a million miles an hour. My anxiety dropped off a cliff, and I suddenly didn’t feel so anxious or nervous. It was almost like walking down a busy street in a city and then suddenly being transported to a forest. This was a feeling that was virtually instantaneous. It didn’t take hours or minutes to happen, it started immediately, and it didn’t wear off after a couple of days, weeks, or months.
History of SGB
So who discovered SGB could be used in this way? It was Dr. Eugene Lipov, a world-renown anesthesiologist and co-founder of the Stella Center in Oak Brook, Illinois, who discovered that SGB could be helpful to individuals with PTSD. For decades, Stellate Ganglion Block had already been used to treat various forms of chronic pain in the neck, back, and arms, and even hot flashes, according to StellaCenter.com. In 2008, Dr. Lipov modified the SGB procedure to treat trauma-related symptoms.
Since then, hundreds of other doctors across the U.S. have begun offering the procedure for PTSD patients, including Dr. Sean Mulvaney at Regenerative Orthopedics and Sports Medicine in Annapolis, Maryland and Dr. Yamilet Neninger at the Pain & Wellness Institute in Tampa, Florida. I have personally been seeing Dr. Neninger. She is an amazing doctor. She has previously worked for the VA and recently became approved through the VA and the military to provide these services to veteran and active duty servicemen.
SGB Success with Veterans
Dr. Mulvaney has been performing SGB for PTSD for a decade. He was featured in a 60 Minutes segment in June 2019 with several patients who noticed positive results immediately after the treatment. Former Marine Corporal Dakota Meyer said he felt completely different within minutes of the injection. He felt calm, “normal,” and could actually breathe again, as if an enormous weight was taken off of him. Another patient, Sgt. First Class Jonathan Zehring, said he felt like a brand new man, like his old pre-combat self again. Plus, he gained a different attitude towards the therapy that, he says, didn’t work for him before.
Growing research shows that a Stellate Ganglion Block can help individuals who have not experienced relief from traditional treatments like therapy and medication. The veterans interviewed on 60 Minutes explained that SGB saved their lives. It may have been their last-resort, but it made all the difference, allowing room for traditional talk therapy to be more effective. In a way, SGB begins to “reset the brain” to a pre-trauma state. It doesn’t cure the PTSD or make the traumatic experiences disappear. Instead, it calms the heightened reaction to those experiences, which then allows the patients to be more open and willing to try other therapies and accelerates the positive impact of those therapies. SGB is not condoned as a stand-alone treatment for PTSD; patients should still seek psychiatric therapy to achieve long-term, ongoing results.
The U.S. Army has poured millions of dollars into SGB for trauma-related research. The most recent research study, which included Dr. Mulvaney as a co-author, was published in the JAMA Psychiatry Journal in November 2019. This first-of-its-kind randomized clinical trial showed that SGB injections reduced PTSD symptoms at roughly twice the rate of a placebo. The study took place between 2016 and 2018 and involved more than 100 active-duty service members at three U.S. Army Interdisciplinary Pain Management Centers. The service members were given an initial SGB or placebo injection, and then two weeks later, they received a second injection. After only 8 weeks, those who received the SGB treatment improved an average of 12.6 points on their total symptom severity scores, while those who received a placebo injection improved by 6.1 points. The improvements from the block injection were substantial enough that the participants could feel the difference.
This study reiterates the reduction in symptoms that other military members previously reported after just one or two treatments. A review published in the journal Military Medicine in 2014 found that more than 70% of patients who received the treatment reported that their symptoms were reduced after just one injection. The anesthesia may wear off within hours, but the positive effects can last for weeks—even up to 6 months or longer for some patients.
Further studies are needed on the Stellate Ganglion Block as an adjunct treatment for PTSD, but clearly, this could be a game-changer for so many Americans who suffer from debilitating trauma-related symptoms. The SGB procedure can help not only veterans, but also first responders, firefighters, law enforcement, abuse survivors, and others who are diagnosed with PTSD after experiencing various traumas.
SGB is commonly used to treat pain, but it’s still not widely available for treating trauma-related symptoms. It was launched as a PTSD treatment at California’s VA Long Beach Healthcare System in 2017. Still, veterans can only be treated with SGB specifically for PTSD at a small portion of the 172 VA hospitals in the United States. It’s usually performed in the pain clinic at the facility and may require a referral from a psychiatrist. Outside of the VA system, most veterans and civilians tend to hear about the treatment through word of mouth and can get it at a private clinic such as the Stella Center in Illinois, the Pain & Wellness Institute in Florida or Regenerative Orthopedics & Sports Medicine in Maryland, as mentioned above. Additional pain clinics that offer SGB and recognize it as a PTSD treatment can be searched by location at TreatingPain.com.
For more information on past research on Stellate Ganglion Block as a PTSD treatment, visit StellaCenter.com and DrSeanMulvaney.com. To watch patient testimonials and view media reports about this treatment, visit StellaCenter.com.
Personally, if you are struggling with PTSD, I would suggest you give it a try. If it works for you as it has for me, then this may be a game changer to improve the rest of your life. If it doesn’t work, then at least you’ll have tried it. I recently learned that my VA doctor can prescribe this as an outpatient service, meaning it’s free for the veteran.
In the last twelve months, I’ve had a total of five of these treatments. Three injections on my right neck and two on my left. I received a few more injections than most, but I have also been struggling with this for more than a decade. For me, it took a few injections for me to fully achieve the results I was looking for. I firmly believe it has been worth it and would recommend it to any veteran dealing with PTSD.