Blocking PTSD’s Effects

Cost-effective injections of an anesthetic into a set of nerves in the neck can help with depression, anxiety and insomnia.

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Helping U.S. military men and women cope with the perils of service has long been a focus of our nation’s defense, veteran and medical communities. For instance, much research and testing have gone into post traumatic stress disorder, which has been diagnosed in warriors throughout the 1900s and into the 21st century.

One treatment showing positive results involves blocking a nerve set known as the stellate ganglion; it has relieved some symptoms, such as depression, anxiety and insomnia, for many service members.

The stellate ganglion – at the base of the neck in front of the sixth and seventh cervical vertebrae – is named for its star shape and is part of the sympathetic nervous system, which triggers a physiological reaction during acute stress (sometimes called the fight, flight or freeze response). Blocking the stellate ganglion can treat a variety of conditions, including complex regional pain syndrome, phantom pain, Raynaud’s disease and shingles.

“A local anesthetic is injected onto [the stellate ganglion] in the front of the neck,” says anesthesiologist Aaron Miranda, a visiting physician with the Ascension St. John Pain Management Clinic in Tulsa. “We usually use fluoroscopic [X-ray] or ultrasound guidance for accurate placement and safety. This is an outpatient procedure which usually takes a few minutes to perform. Usually, patients report immediate improvement in their symptoms within minutes.”

Miranda says growing evidence suggests stellate ganglion blocks may reasonably treat PTSD.

According to the U.S. Department of Veterans Affairs, the number of veterans with PTSD varies by service era. Between 11% and 20% of those serving in Operations Iraqi Freedom and Enduring Freedom, about 12% of those in Operation Desert Storm and the Persian Gulf War, and an estimated 30% percent of Vietnam veterans have sought treatment for PTSD.

Joysree Subramanian, an anesthesiologist and pain medicine specialist with OU Medicine, says the stellate ganglion block has been used to treat PTSD since 2008, but there has been renewed interest in its use for several reasons.

“The first line of treatment – psychotherapy, pharmaco-therapy or a combination – has its own challenges and limitations,” says Subramanian, adding that the stellate ganglion block may be a good option to supplement existing therapies, reduce the use of medications or help individuals who have not responded to conventional treatment.

She says more research is needed to support the routine use of the procedure and some studies have “concluded that there was substantial beneficial psychiatric effects and substantiates that this immediate acting procedure may provide positive results for patients with PTSD and reduce barriers to treatment.”

Subramanian also says “the stellate ganglion block may be more cost-effective, even if repeated blocks are performed, compared to other treatments, like cranial electrical stimulation, psychotherapy and pharmaco-therapy, which have their own potential harms. It is a very useful block to reduce the use of medication, especially opioids for pain and benzodiazepines for anxiety.”