In the JournalsPerspective

Experts propose nerve blocks to treat PTSD

Researchers are focusing on an innovative technique to treat refractory posttraumatic stress disorder by influencing the sympathetic nervous system, according to an article published in Psychiatric Annals. The article is part of a 6-month series examining the use of complementary and alternative medicine in the treatment of PTSD.

Anita H. Hickey, MD, a captain at the Naval Medical Center San Diego, and colleagues said the stellate ganglion block (SGB) technique, which has long been used for pain management, can have important implications for treating the disorder.

“Cumulatively, the growing body of preliminary evidence about the potential therapeutic benefits of SGB for PTSD is compelling,” they wrote.

SGB is a method of anesthetizing nerves in the stellate ganglion, located at the level of the sixth and seventh cervical vertebrae, resulting in a “calming effect” on patients that can mitigate symptoms of avoidance and hyperarousal.

There is no standardized SGB technique, but Hickey and colleagues recommend a common approach of using fluoroscopy or ultrasound to ensure that the anesthetic has been safely delivered via injection to the right side of the neck. The level of the C6 vertebra is preferable to avoid injury to the vertebral artery.

Patients may require at least two SGB treatments during a short follow-up period to experience sustained relief of PTSD symptoms, according to the researchers.

Hickey and colleagues reported on a number of studies, dating to 1990, which add to a growing body of evidence about the potential benefits of SGB treatments in patients with refractory PTSD.

SGB has been used in the treatment of depression as early as 1947, and more recently the approach has helped reduce hallucinations associated with schizophrenia, according to background information in the article.

Common treatment approaches to PTSD with psychotherapy and psychopharmacology may take weeks and even months to be effective and are subject to high attrition rates. The therapeutic benefits of SGB, however, are almost immediate.

“Although getting an injection in the neck to treat PTSD might seem off-putting to some, SGB has been used for many decades as a successful pain management technique where it has proven to be popular, tolerable and safe,” the researchers wrote.

To read the full article, click here.

Elspeth Cameron Ritchie, MD, MPH

Elspeth Cameron Ritchie

  • It could be argued that this technique does not fall under the rubric of complementary and alternative medicine, which traditionally focuses on herbal medicine and acupuncture. That is somewhat true. It is a standard invasive procedure commonly performed in ambulatory facilities, outpatient surgical centers, procedure suites in physicians’ offices, as well as in hospitals. However, it is a new, promising, and as yet unproved technique for the treatment of PTSD.

    It is clear that new methods of treatment for PTSD are desperately needed. Although psychotherapy and pharmacotherapy are effective for many who are willing to go through the treatment regimen, they are not effective for all. Perhaps more importantly, many service members will not go to the current treatment regimens or stick to it for the 20 sessions often required for prolonged exposure therapy or the weeks or months for pharmacotherapy. The time required is too much for most service members, who usually have a very full schedule of deployments or trainings in the field.

    I am not at all dismissing the benefits of psychotherapy or pharmacotherapy. They are evidence-based treatments. However, I do suggest this exciting new technique is a modality that should be further studied. Other modalities in the treatment of PTSD will be explored in Psychiatric Annals, including virtual reality, acupuncture, and animal-assisted therapy, throughout 2013.

    • Elspeth Cameron Ritchie, MD, MPH
    • Retired Army Col.
      Chief Clinical Officer
      District of Columbia Department of Mental Health
  • Disclosures: Dr. Ritchie reports no relevant financial disclosures.