At Crownview Psychiatric Institute, we have extensive experience working with people with a history of trauma, people who have experienced a traumatic event or events, and people who meet the clinical diagnostic threshold for severe and/or complex PTSD. Out treatment team uses talk therapy, educational programs, and a whole-person approach to recovery, designed to provide our clients with the skills they need to return to their daily activities and lead a full and productive life.
In some cases, when indicated by a comprehensive psychiatric assessment, medication is an important part of the treatment plan for people with a history of trauma or people diagnosed with severe and/or complex PTSD.
One medication-based approach we use is called the stellate ganglion block (SGB).
What is a Stellate Ganglion Block (SBG)?
The stellate ganglion block is a process that involves the injection of a local anesthetic into the stellate ganglion, which is a cluster of nerves located in the neck on both sides of the voice box. The injection eases pain in the upper neck, head, upper chest, and upper arms. In fact, scientists initially developed SGB for this purpose: pain relief.
However, researchers realized that because the stellate ganglion is part of the sympathetic nervous system, which itself is directly involved in the symptoms of PTSD, blocking the action of the nerves in the stellate ganglion might be beneficial for people with PTSD.
The goal of the SGB for PTSD is to provide relief from symptoms such as sleep disturbance, anxiety, irritability, difficulty concentrating, jumpiness, sever headaches, and other life-altering, disruptive symptoms related anxiety disorders. These symptoms are very common in people diagnosed with all types of PTSD.
SGB: The Procedure
Only licensed physicians are qualified to administer the SGB.
With the support of our experienced nursing team, one of our trained, skilled physicians uses image-guided techniques to inject a local anesthetic into the stellate ganglion. This cluster of nerves, when stimulated, prepares a human for stress by increasing heart rate, increasing blood flow to the muscles, and decreasing blood flow to the surface of the skin.
When interrupted by a local anesthetic, these phenomena cannot contribute to PTSD symptoms associated with the SGB. After the SGB block injection, many patients report relief from the symptoms of anxiety and PTSD.
This includes a restored sense of safety that allows patients to fully commit to and participate in the other types of therapy common for the treatment of PTSD, including trauma-focused cognitive behavioral therapy (TF-CBT), dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), prolonged exposure therapy (PE), and others.
Stellate Ganglion Block and PTSD
PTSD is a life-altering disorder that can be debilitating.
The SGB is part of the sympathetic nervous system, which, as we discuss above, is known to contribute to the symptoms of PTSD. Mental health professionals understand that extreme trauma can have a negative impact on this system. One way to think about an extreme trauma – and its persistent side effects – is that it can cause the part of the sympathetic nervous system involved in our fight or flight response to become permanently activated.
In other words, the fight or flight response gets stuck in the always on position.
That’s why PTSD symptoms may persist for years: the sympathetic nervous system does the right job, but at the wrong time, and for far too long.
PTSD: Important Facts
PTSD can develop in individuals who have lived through a shocking, dangerous, or traumatic event. A violent, unpredictable event often leads to PTSD, such as a physical attack or a car accident. But an overt, sudden, violent event is not the only thing that can lead to PTSD. Unexpected life events, such as the sudden death of a loved one, can also lead to PTSD. Symptoms typically begin within three months of the traumatic incident, and may last for years.
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These symptoms of PTSD are often disruptive and cause significant medical, interpersonal, and social impairment. There are various treatments available for PTSD, including psychotherapy and medicine. SGB has shown to be effective for those who have not fully responded to conventional therapies.
The National Institute of Mental Health (NIMH) indicates that anyone can develop PTSD at any age. To meet the diagnostic criteria for PTSD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-5), an adult must show the following for at least one month:
- At least one re-experiencing symptom, such as a flashback, bad dreams, or frightening thoughts
- One avoidance symptom, such as avoiding thoughts or feelings related to the traumatic event or avoiding objects, events, or places associated with the event
- At least two arousal and reactivity symptoms, such as being easily startled, feeling tense and on edge, having difficulty sleeping, and experiencing angry outbursts
- At least two cognition and mood symptoms, such as trouble remembering the traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, or a loss of interest in enjoyable activities
First-line treatments for PTSD include psychotherapy, medication, or a combination of the two.
However, for some people, these approaches simply do not work. In the beginning of the treatment process, some patients cannot engage in talk therapy without experiencing negative consequences, such as re-traumatization, which is exactly what they want to avoid. SGB provides an alternate, innovative approach to improving the health and well-being of people with PTSD.
Some of the potential benefits of SGB for PTSD include:
- Many people reluctant to rely on psychotherapy or medication to treat their symptoms.
- For some, the knowledge that they are undergoing a physical procedure to treat their mental illness can validate the severity of their PTSD without robbing them of their agency.
A fast-acting treatment alternative:
- Some patients report improvements within minutes and some within days of the procedure
- Many patients with PTSD do not want to wait for psychotherapy or typical medication to work: they want relief from their painful, disruptive symptoms as soon as possible, as is possible with the SGB
- SGB may reduce symptoms of PTSD for days to weeks, reducing the need for daily medication or daily psychotherapy
- For some patients, this option works best: they prefer a course of treatment that does not require a high level of maintenance
Is a Stellate Ganglion Block Right for You?
The only way to answer this question is through consultation with your medical team after a comprehensive psychiatric and biopsychosocial assessment, administered by a licensed, qualified, and experienced mental health professional.
An accurate diagnosis is the first step. Collaboration with a skilled treatment team is the second step, which can lead to a treatment plan that may or may not include SGB.
In some cases, psychotherapy, medication, and an intentional focus on symptom management, emotional regulation, and life skills lead to a full recovery from PTSD. In cases where patients require additional help, we find SGB treatment an effective approach for people with severe, complex PTSD symptoms.
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If you or someone in your family has been struggling with acute symptoms of posttraumatic stress disorder, the stellate ganglion block may be an appropriate treatment that can bring relief from severe PTSD symptoms quickly.