Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

Abstract

IMPORTANCE This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms.OBJECTIVE To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) total symptom severity scores from baseline to 8 weeks. DESIGN, SETTING, AND PARTICIPANTSThis multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist-Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months.INTERVENTIONS Paired right-sided SGB or sham procedures at weeks 0 and 2.MAIN OUTCOMES AND MEASURES Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). RESULTSOf 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was −12.6 points (95% CI, −15.5 to −9.7 points) for the group receiving SGB treatments, compared with −6.1 points (95% CI, −9.8 to −2.3 points) for those receiving sham treatment (P = .01). CONCLUSIONS AND RELEVANCEIn this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03077919

Treatment of multiple physiological and psychological disorders in one patient with stellate ganglion block: a case report

“…Clinical symptoms and psychological scale scores of patients with PTSD treated with SGB improved considerably, with patients sleeping better and remaining in a more stable emotional state than before treatment. 4,5 Our patient exhibited a marked improvement in sleep after receiving SGB, indicating that even for patients with a complicated and severe clinical presentation, SGB can provide visible benefits.…”

“…SGB has been used to treat this disorder and relieve sympathetic hyperactivity in the long term. 4,5 This fast-acting, somatic approach can reduce the barriers that prevent patients from receiving therapy, which are frequently encountered in the treatment of anxiety and insomnia, 6 particularly among the military population. Most patients who benefit from SGB present with only one or two symptoms.…”

Stellate ganglion block treats posttraumatic stress: An example of precision mental health

“…A small sample of these cases is documented in the literature primarily in level 3 studies, yet if the collective results are considered in entirety, they show great consistency in SGB effects. There are 14 original studies published since 1990 in the peer‐reviewed medical literature documenting SGB’s successful treatment of PTSD symptoms (Alino, Kosatka, McLean, & Hirsch, 2013; Alkire et al., 2014; Alkire et al, 2015; Hanling et al., 2016; Lebovits, Yarmush, & Lefkowitz, 1990; Lipov, Joshi, Lipov, Sanders, & Siroko, 2008; Lipov et al., 2012, 2013; Lynch et al., 2016; McLean, 2015; Mulvaney et al., 2014; Mulvaney, Lynch, de Leeuw, Schroeder, & Kane, 2015; Mulvaney, McLean, & De Leeuw, 2010; Rae Olmsted et al, 2020). In November 2019, a large multicenter, randomized clinical trial demonstrated twice the effect of SGB over a sham procedure (Rae Olmsted et al, 2020).…”

Stellate Ganglion Block Brain Protection During Ischemic Stroke in Diabetes Rats: TLR4/NF-κB Pathway and Inflammation

“…Stellate ganglion block (SGB) is a technique unique to the Department of Anesthesia, which plays an unparalleled role in the treatment of many diseases. [6][7][8] The TLR4/NF-κB pathway is also a classic in ammatory pathway. 9 It has been reported that SGB can signi cantly reduce the in ammatory response.…”