Is A Stellate Ganglion Block Right For You
A stellate ganglion block may be right for you if you have nerve pain in the head, neck, upper arm or upper chest that does not respond to other treatment.
Talk to your physician about it. To schedule an evaluation at Cleveland Clinics Department of Pain Management call 216.444.PAIN or 800.392.3353
Standard Treatment For Ptsd:
Despite currently availabletreatments such as medications and Psychotherapy, around 50-70% individualscontinue to struggle with PTSD symptoms and discontinue treatment before makingenough progress in their treatment. Current challenges of standard treatmentare:
- Slow onset of action of medications
- Medications effective for only 30-50% individuals
- Continued side effects of medications
- Need for prolonged patient involvement for Psychotherapy
Role of Sympathetic nervous system in PTSD:
The sympathetic nervous system is part of Autonomic nervous system, which on activation mobilizes our bodily resources for flight or fight response. It leads to increase in heart rate, alertness, arousal needed to tackle the acutely stressful situation.
Many research studies suggest that the continuous dysfunction of the sympathetic nervous system in PTSD causes prolonged arousal, hyper-vigilance, and aggravates PTSD related anxiety symptoms.
Summary Of Critical Appraisal
Additional details regarding the strengths and limitations of included publications are provided in .
As per AMSTAR II criteria, the included SR was generally well-conducted, with clearly stated objectives, inclusion and exclusion criteria, and key search terms. The SR authors followed an a priori study protocol, provided search strategies, searched multiple databases, provided justification for included study designs, and provided a list of included and excluded studies. Furthermore, details of study selection were explicitly stated and data extraction was conducted in duplicate, which decreases the risk of missing or inaccurate data and/or biased study selection. A grey literature search was conducted, which decreases the risk of missing relevant, non-indexed studies. The SR authors disclosed their funding source and that there were no conflicts of interest.
Randomized Controlled Trial
For methodological strengths, the identified RCT: 1) had clearly stated objectives, inclusion and exclusion criteria, interventions, outcome measures, and main findings 2) used blinding of participants and research coordinators to help reduce bias 3) planned data analyses at the outset of the study 4) conducted a sample size calculation 5) specified the time period over which patients were recruited and 6) discussed potential adverse events relating to the interventions.
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What Does Sgb Treat
In clinical practice and research, Dr. Mulvaney and Dr. Lynch have extensively practiced and published the use of SGB to treat the anxiety symptoms associated with PTSI. They have also used SGB to successfully treat other anxiety conditions, vasomotor symptoms associated with menopausal hot flashes, as well as helping reduce symptoms during treatment for substance addiction.
SGB is not a treatment for depression, bipolar disorder, schizophrenia or any variants of schizophrenia, personality disorders or seizure disorders.
Anxiety And The Stellate Ganglion Block: The Perfect Match
Anxiety is a mental health condition that affects all areas of the sufferers life. It can mean that they become solitary and introverted, and they might have problems holding down a job or developing good relationships. In some cases, the sufferer might even attempt to harm themselves or commit suicide.
There are a number of different ways that anxiety can be treated, but one of the newest, and possibly most exciting, is the stellate ganglion block injection. Although it has been performed since 1925, it is only recently that this procedure has been noted to help with anxiety and other conditions, such as PTSD.
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About Sgb And Its History
SGB is a safe, ultrasound-guided injection that targets a collection of nerves in the neck, blocking impulses that trigger fear- and anxiety-based responses in our bodies, such as with post-traumatic stress disorder . According to the Diagnostic and Statistical Manual of Mental Disorders , post-traumatic stress disorder is a pathologic trauma and stressor-related disorder that occurs following exposure to severe trauma and affects approximately 10 million Americans.
SGB is an outpatient procedure, taking less than thirty minutes to administer. The effects, which are often felt immediately, can last for years. Generally, there are two injections within ten to fourteen days of each other. The first injection is thought of as resetting the nervous system, while the second one boosts the first doses effects. These help to effectively reboot the nervous system towards a pre-trauma state.
SGB actually has a long history. It was used to help German prisoners of war recover from their experiences in Russian camps during World War II. And even right here in the United States, it has been used for nearly 100 years to relieve chronic pain and depression, as well as within our military to help active soldiers and those returning from duty. Yet, it wasnt until after 1998 that it was used more regularly in our country.
Stellate Ganglion Block For Depression
The SGB injection is a popular treatment option for those who are struggling with Post Traumatic Stress Disorder . Doctors are also looking at using it to treat and reduce pain and symptoms that come with depression and anxiety. Many people view it as a suitable treatment option, as there are no significant side-effects. However, this is also because the risk factors are minimal.
The SGB procedure entails administering an injection of local anesthetic into the neck to dull a persons fight or flight response. Due to the positive changes in critical areas of the brain, it gives patients with PTSD the possibility of feeling less pain and discomfort and regaining control over their life again.
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Why Choose The Albany Clinic For Treatment
At the Albany Clinic, we treat Treatment-Resistant Depression with IV Drug Infusion Therapy. IV Drug Infusion Therapy delivers medications as a constant infusion. Ketamine is the primary medication used in these infusions, and it achieves rapid symptom relief. There are now dozens of studies that have been performed in multiple countries which have demonstrated ketamines efficacy. Ketamine has a distinct advantage over the traditional medications used because of the rapidity with which it relieves symptoms. This can be life saving, especially when suicidal ideation is present.
The Sgb Injection For Depression: Does It Work
Being clinically depressed makes it more difficult to take care of yourself and function daily. Many challenging side effects come along with this diagnosis, and they can often be quite debilitating. It leaves many people feeling hopeless and anxious about the future. Doctors and medical professionals alike are working hard to help patients who are struggling with depression and are looking for a way to get back to living life to the fullest.
If youre someone who suffers from depression, then you may want to consider the stellate ganglion block injection for helping to relieve your symptoms. Its proven to treat all types of PTSD, and researchers remain hopeful that it may also be effective in treating anxiety and depression.
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Ultrasound Vs Fluoroscopic Sgb
Ultrasound allows the needle to be safely guided around the nerves and blood vessels in the neck as it is placed next to the stellate ganglion. Under x-ray guidance, only bones are visible, and nerves are not visible at all, therefore position of the nerves can only be approximated. Using ultrasound guidance to safely perform an SGB takes special additional training and considerable skill which many pain medicine trained physicians do not have.
During his fellowship in anesthesia/pain medicine at Walter Reed National Military Medical Center, Dr. Mulvaney learned to do SGBs with fluoroscopic-guidance. He rejected this method, as compared to ultrasound-guided SGB, as it was more painful, less efficacious and exposed patients to ionizing radiation from the xray.
Selection Criteria And Methods
One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in .
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What Causes Anxiety Or Ptsd
Anxiety and PTSD are caused by a mis-match where our nervous system over responds to its environment. So principally it makes sense to treat this problem in two ways:
1) Dampen the physiological response to a stressor or trigger. A Stellate Ganglion Block can effectively do this.
2) Work with a qualified professional to gain tools to understand why you are experiencing these feelings and learn how to work around them.
How Does Sgb Injection For Ptsd Work
The stellate ganglion is a group of nerves in the neck. When this is blocked , the fight or flight nerve center in the body is anesthetized. This means that the hormones in your body arent flooding it, and you are better able to think clearly, to relax more, and not be overwhelmed with stress.
The stellate ganglion block for PTSD procedure takes about 10 minutes to carry out, and usually within 30 minutes the patient will start to feel a difference in their mental state. It is a low risk procedure that many people find helps them immensely.
Why Such a Good Match?
Its easy to see how this PTSD injection treatment works, but why is it such a good match for those who suffer from anxiety? Its not just about how it works, but about the procedure and everything around it as well.
When you have the SGB injection to treat PTSD, the procedure is relatively non-invasive, pain-free, and performed quickly. So for those with anxiety who therefore worry about so much in their lives, this is something that you dont need to think about it will be done quickly and simply without affecting your anxiety or the rest of your life, and when it is done, you will feel better in general.
Other treatments for anxiety such as group therapy can make the sufferer feel worse as they can worry about the condition for a long time beforehand, and then become overwhelmed by the experience when it happens even for a while afterwards. This is not the case with this new PTSD breakthrough injection.
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History Of Sgb Injections
The Stellate Ganglion Block was first used in the United States in 1925. The original purpose of the procedure was to provide relief of chronic pain. It has been administered millions of times since then, all across the globe. SGB was first used for depression in 1945 in The Cleveland Clinic. Unfortunately, its psychiatric impact potential was forgotten. Then in 1998 , a Finnish physician treated a patient who was suffering from both severe hand sweating and PTSD. The procedure for hand sweating involved modulating the sympathetic nervous system in the upper chest . Much to the doctor’s surprise, the patient reported relief of hand sweats as well as relief from his PTSD symptoms. During my research I realized that the Finnish doctors PTSD success could be achieved more easily and safely by blocking the sympathetic nervous system in the neck rather than the chest. Since 2007, I have performed over 550 SBG procedures for PTSD. An additional 2,000 SGB procedures have been performed by colleagues, mostly doctors in the US Army.
Context And Policy Issues
Post-traumatic stress disorder can develop after exposure to a traumatic event related to combat or any life-threatening experience. Common symptoms of PTSD may include recurring nightmares, loss of interest in activities, inability to feel pleasure, difficulty concentrating, and insomnia. Subsequently, PTSD is a debilitating condition that is linked to reduced quality of life, depression, and anxiety. According to a CAMH paper published in 2018, the lifetime prevalence rate of PTSD for Canadians in general is approximately 9%, whereas 29% of police officers surveyed from 2 Canadian police departments were in the diagnostic range for PTSD. Furthermore, according to a Veteran Affairs Canada article published in 2019, up to about 10% of war zone Veterans will exhibit PTSD.
Treatments for PTSD typically involve psychotherapy and/or pharmacotherapy. Various forms of psychotherapy may be used such as exposure-based therapy, cognitive behavioural therapy, and stress inoculation training. Pharmacological treatment options may include antidepressants , antipsychotic drugs, mood stabilizers, and/or other agents. However, success rates of PTSD treatments are generally variable, with remission rates that range from 30% to 40%. Thus, alternative therapies such as stellate ganglion block are being evaluated for the treatment of PTSD.
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Quantity Of Research Available
A total of 183 citations were identified in the literature search. Following the screening of titles and abstracts, 177 citations were excluded and 6 potentially relevant reports from the electronic search were retrieved for full-text review. Four potentially relevant publications were retrieved from the grey literature search for full-text review. Of these potentially relevant articles, 7 publications were excluded for various reasons and 3 publications met the inclusion criteria and were included in this report. These comprised 1 SR, 1 RCT, and 1 evidence-based guideline. presents the PRISMA flow chart of the study selection. Additional references of potential interest are provided in .
Gold Standard Evidence Supporting Sgb
Since 2010, several US military treatment facilities have used Stellate Ganglion Block effectively to help thousands of service members suffering from symptoms associated with PTSD.
This has been an effort to help keep warriors on combat teams at top performanceto hone the edge of a knife that has dulled with hard use.
There are 15 original studies published since 2008 in the peer-reviewed medical literature documenting SGBs successful treatment of PTSD symptoms. In November 2019, a large multi-center, randomized clinical trial was published in JAMA Psychiatry demonstrating twice the effect of SGB over a sham procedure. Now with gold standard Level 1 evidence supporting SGB, many clinicians believe this procedure should be incorporated into standard PTSD care.
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What Is A Stellate Ganglion Block
The stellate ganglion block is a procedure in which an injection of a long-acting local anesthetic, using ultrasound or fluoroscopic guidance, is made in the right side of the neck around the main nerve that controls the fight or flight response . This nerve, which is a two-way conduit, connects the parts of the brain that control the fight or flight response to the rest of the body. By blocking or turning off the traffic in the cervical sympathetic chain, it is believed that the parts of the brain that control the fight or flight response are allowed to completely reset, resulting in long-term relief of the associated anxiety symptoms.
Multiple peer-reviewed medical studies show that a right-sided SGB results in significant long-term improvement in chronic anxiety symptoms associated with post-traumatic stress injury . The SGB takes less than 15 minutes to perform, and benefits are seen in as little as 30 minutes.
Start Getting Treated Now
If you find yourself suffering from the effects of depression and think SGB is the solution for you, call Pain and Spine Specialists today! We are a team of highly qualified providers who will properly evaluate your symptoms and determine the best course of treatment. Let us help you return to a fully functioning life, free from pain. Call 703-8767 , 603-3560 , or 433-1905 and schedule an appointment today.
We believe that a comprehensive pain program is the only way to provide the greatest opportunity for long-term benefit and recovery.
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Coping With Collective Social Stress
For this challenge, the best defense is a friendly offense. If we can be the person to reach out to others with a friendly hello and a direct, kind gaze, we can create a little protection for ourselves, and maybe even others. We have no idea what kinds of stressors or capital T traumas those we encounter may be going through. I recently had to make multiple visits to my local post office over several weeks. One of the postal employees looked really beaten down one day, so I asked her how she was doing, really. She told me that she had lost two family members, one to COVID, and one who was shot and killed in the line of duty as a police officer. At the same time, I was grieving the loss of a special person, a former patient who had died of a heart attack. She and I had a brief moment of connection around these losses that helped both of us.
How A Stellate Ganglion Block Is Done
During a stellate ganglion block, pain-relieving medicine is injected to the region where the ganglion lies. This may reduce the release of the chemical norepinepherine activating the pain sensitive nerves and reduce the pain.
The patient is usually sedated, and using X-ray guidance, a fine needle is placed near the stellate ganglion and anesthetic is injected.
The patient will not feel numbness in the face. They will have a droopy eye, redness of the eye, feel warmth in the face and may experience hoarseness of the voice. These effects are temporary and last a few hours. Pain relief may also not be immediate. A pain diary is used following the procedure to track the response.
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Stellate Ganglion Block May Promote Placebo Effect In Ptsd
A novel treatment for post-traumatic stress disorder turned out to be no better than sham treatment in a randomized controlled trial, disappointed researchers reported in a poster presentation at the 31st Annual Meeting of the American Academy of Pain Medicine.
Although stellate ganglion block had reportedly induced rapid, dramatic, and long-lasting improvements in PTSD symptoms in case series and uncontrolled trials, researchers from the University of California, San Diego, the Naval Medical Center in San Diego, and the Naval Hospital of Okinawa, Japan were unable to replicate the results under more controlled conditions.
The stellate ganglion nerves in the back of the neck are thought to influence fight or flight response and mediate pain signals. The response can be blocked by injecting a local anesthetic, after which some physicians have noted an improvement in depression, nightmares, flashbacks, and anxiety in patients.
The researchers set out to prove the impressive claims by injecting 42 military service members with PTSD with either stellate ganglion block or a sham injection. PTSD severity was measured one week and one month after injection. Patients who continued to meet PTSD criteria were able to get a second injection or switch from sham to the stellate ganglion block. Pain, depression, anxiety, cognitive function, and disability were also measured.