By James H. Lynch, MD, The Stellate Institute, Annapolis, USA
“Doc, you saved my marriage.” “My son dropped the plate, and I would’ve normally flown off the handle at him, but I didn’t. Thank you so much Doc (with tears in his eyes).” These are comments from my patients that I hear after performing administration of stellate ganglion block (SGB) for posttraumatic stress disorder. I have had no greater level of professional gratification than hearing from a wife of a career Soldier and hardened combat veteran, “Thank you for giving me my husband back.”
Stellate Ganglion Block—a safe outpatient procedure that improves sympathetically-mediated post-traumatic stress symptoms—is an injection of long-acting anesthetic around the cervical sympathetic chain in the neck which reduces patient-reported symptoms by ~50% and lasts for months.
As many experienced therapists know from clinical practice, a finding which is reinforced by research, exaggerated hyperarousal is an independent predictor of nonresponse to standard PTSD treatment. There are many approaches to address hyperarousal, but some, especially medications such as benzodiazepines have undesired side-effects such as dependency. New insights about the role of the cervical sympathetic chain and the amygdala and hippocampus now allow us to directly address some of the most debilitating symptoms experienced in post-traumatic stress. Key to this new understanding is a cluster of nerves in the autonomic nervous system called the stellate ganglion that lies along the cervical sympathetic chain in the neck, just above the collarbone. By administering an ultrasound-guided injection of local anesthetic, a successful SGB procedure precisely targets elevated sympathetic tone and re-sets the body’s sympathetic response system.
SGB has been used successfully for over ten years in the US on thousands of patients to treat post-traumatic stress symptoms with a success rate of approximately 70%-80%. The effects of a successful block are immediate and can last from six months to many years when paired with effective psychological interventions. Research has shown consistently that SGB can reduce PTSD symptoms by 50% and is particularly helpful in improving symptoms of irritability, surges of anger, difficulty concentrating, and trouble falling or staying asleep. A level one randomized clinical trial published in JAMA Psychiatry in 2020 demonstrated twice the effect of SGB as compared to sham (placebo) injection. The magnitude of effect and high success rates of SGB are simply too compelling to ignore.
SGB offers a particularly effective option for those experiencing negative alterations in cognition and mood (cluster D) and arousal/reactivity (cluster E) symptoms. SGB does not replace, but rather enhances standard mental health and medical treatments for PTSD due to a variety of traumatic experiences, including combat-related, sexual and physical trauma.
For more information, see https://thestellateinstitute.com/
About Dr. Jim Lynch
Dr. Jim Lynch is a physician who co-founded The Stellate Institute near Washington D.C., after serving 31 years in U.S. Army medicine. He has extensive experience treating those suffering from the effects of trauma. Along with his partner Dr. Sean Mulvaney, Dr. Lynch was a pioneer in the world of PTSD treatment using stellate ganglion block to help heal thousands of patients since 2010. The Stellate Institute has published more original research on this topic than any other scientists in the world while performing more SGBs for PTSD than any other team. Dr. Lynch has firsthand follow-up and continuity with hundreds of his SGB patients, having served in the same Special Operations community with them for over 10 years. This unique follow-up and close collaboration with behavioral health clinicians was pivotal in developing Dr. Lynch’s deep understanding of how best to utilize innovative SGB techniques in conjunction with trauma-focused therapy.
Dr. James Lynch will be presenting at the National Conversation on PTSD 2021. Buy your tickets here.
ABOUT THE SESSION – Treatment Successes in Post-traumatic Stress Using Stellate Ganglion Block:
The stellate ganglion block (SGB) procedure has been used successfully for over ten years to treat posttraumatic stress symptoms in thousands patients suffering in select hospitals in Europe and North America. Primarily through targeting the autonomic nervous system, the SGB procedure serves as an invaluable adjunct to trauma-focused psychotherapy.
SGB has been evaluated and supported in 20 peer-reviewed publications, including a level one randomized clinical trial in 2019 supporting this modality’s safety and effectiveness in the successful treatment of PTSD. SGB effects are immediate and profound with up to 80% of patients reporting a 50% reduction in symptoms.
Given ten years worth of evidence already published on this topic, physicians and behavioral health clinicians should consider utilizing SGB in conjunction with standard trauma-focused care.