Stellate Ganglion Block Used to Treat Symptoms Associated With Combat-Related Post-Traumatic Stress Disorder: A Case Series of 166 Patients

Mulvaney, Sean W.; Lynch, James H.; Hickey, Matthew J.; Rahman-Rawlins, Tabassum; Schroeder, Melanie; Kane, Shawn F.; Lipov, Eugene

doi:10.7205/milmed-d-14-00151

Cited by 56 publications

(60 citation statements)

References 40 publications

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“…The secondary literature search identified an additional 7 publications resulting in 32 publications included in the review. These comprised 15 case reports and case series, 1 systematic case review, 2 publications related to a single published RCT, and 14 nonsystematic reviews, opinions, guidelines, commentaries, books, and book chapters . The systematic search results are shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Following publication of the review by Navaie and colleagues, the largest case series to date was published by Mulvaney et al., examining active‐duty military patients. This study reported patient follow‐up on a cohort of 166 patients for a period up to 6 months and found that administration of a second SGB could improve efficacy …”

Section: Resultsmentioning

confidence: 99%

“…It appears highly plausible that subjects in such a setting might be inclined to underreport any beneficial effects from treatment out of concern that documented improvements during the study might reduce monetary compensation for their disability. In contrast to this military population in which secondary gain was a reasonable consideration, the much larger populations of military personnel and veterans studied by other investigators comprise a diverse patient base, including currently serving active‐duty military—a sizeable proportion of whom continued to deploy following treatment …”

Section: Discussionmentioning

confidence: 99%

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Stellate Ganglion Block in the Treatment of Post‐traumatic Stress Disorder: A Review of Historical and Recent Literature

Summers

Nevin

2016

Pain Practice

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Concerns over the rising prevalence of post-traumatic stress disorder (PTSD), particularly among military service members returning from combat, and over barriers that hinder individuals from seeking out or adhering to standard therapies have contributed to interest in alternative therapies for the disorder. A novel alternative therapy for PTSD-stellate ganglion block (SGB)-may be considered lacking in formal evidence of efficacy despite having shown considerable promise. This review of the recent and historical literature related to SGB finds evidence of substantial beneficial psychiatric effects and substantiates that this fast-acting, somatic treatment may provide positive results for patients with PTSD and may reduce barriers to therapy, particularly among military populations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stellate Ganglion Block in the Treatment of Post‐traumatic Stress Disorder: A Review of Historical and Recent Literature

Summers

Nevin

2016

Pain Practice

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“…The other paper was by Dr. Mulvaney (where the primary author of current report was the senior author) studies have shown that the SGB. improves blood circulation by inhibiting the activity of the sympathetic nervous system[3], it is not clear which circulation is being addressed and how long this vasodilation lasts. Actually, impact of SGB on circulation has been studied and has been demonstrated to have no impact[4].…”

Section: To the Editormentioning

confidence: 99%

“…For example, in chemically sympathectomized animals, antibody and cell-mediated responses are altered[5]. Central effect of SGB on NE, leading to its reduction, has been postulated by Dr. Mulvaney to explain significant effect of SGB on post traumatic stress disorder (PTSD), a condition known to have elevated NE levels[3]. Further evidence exists as to the SGB impact on proinflammatory cytokines.…”

Section: To the Editormentioning

confidence: 99%

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

Lipov

Candido

2017

WJG

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Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

et al. 2020

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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

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Stellate Ganglion Block Used to Treat Symptoms Associated With Combat-Related Post-Traumatic Stress Disorder: A Case Series of 166 Patients

Abstract: Selective blockade of the right cervical sympathetic chain at the C6 level is a safe and minimally invasive procedure that may provide durable relief from anxiety symptoms associated with PTSD.

Cited by 56 publications

References 40 publications

Stellate Ganglion Block in the Treatment of Post‐traumatic Stress Disorder: A Review of Historical and Recent Literature

Stellate Ganglion Block in the Treatment of Post‐traumatic Stress Disorder: A Review of Historical and Recent Literature

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

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