Injection shows promise for PTSD treatment in clinical trial

Dr. Jeffrey Tiede, director of the Interdisciplinary Pain Management Center at Landstuhl Regional Medical Center, injects a local anesthetic into Master Sgt. Randall Kimble's neck during a stellate ganglion block procedure at LRMC in 2016. A Pentagon-funded clinical trial found that PTSD symptoms of service members who received the procedure showed significant improvement, according to the results announced Wednesday.


By JENNIFER H. SVAN | STARS AND STRIPES Published: November 7, 2019

KAISERSLAUTERN, Germany — Injecting a local anesthetic next to a bundle of nerves in the neck can significantly reduce post-traumatic stress disorder symptoms in service members, based on the results of a two-year clinical trial published Wednesday.

The Pentagon-funded trial conducted at two military medical centers in the U.S. and one in Germany found that PTSD symptoms improved after service members received injections of stellate ganglion block. The findings were published in the medical journal JAMA Psychiatry. The findings, published in the medical journal JAMA Psychiatry, could revolutionize the way service members and veterans are treated for PTSD.

“This does represent a new treatment option,” Kristine Rae Olmsted, one of the lead investigators on the trial, told Stars and Stripes.

“In the hands of a qualified physician, it can really represent relief for people who are suffering from PTSD,” said Rae Olmsted of the RTI International research institute, which received a $2 million grant from the Defense Department to conduct the trial.

With 108 participants, the study was the largest random, controlled trial of the SGB injection for PTSD, and the first to be carried out simultaneously at multiple sites.

Participants’ PTSD symptoms were assessed by a mental health professional before they received the first of two placebo or SGB injections, and again eight weeks later. The mental health interviewer did not know which participants were receiving the placebo and which the active SGB injections.

At the eight-week assessment, symptom relief was found to be significantly better for patients who were given the SGB shot, the study said.

One participant described feeling “a radical change … the first day. It has helped me not to be stressed and angry all the time. I can now let stuff go rather than blowing up about them,” the study said.

“I do think, based on the findings of our research, that stellate ganglion block can be considered a new treatment option for PTSD,” Rae Olmsted said.

Further studies are planned to determine, among other things, how SGB works and how long its positive effects last.

Chicago anesthesiologist Dr. Eugene Lipov, who pioneered the use of SGB to treat PTSD more than 10 years ago, said he believes the block reduces a protein necessary for nerve cell survival and new nerve growth, called nerve growth factor, or NGF, to pre-trauma levels.

NGF can surge in response to stress and fear, causing new nerve endings to sprout in the brain, Lipov said in a 2016 interview with Stars and Stripes. Those excess nerves produce norepinephrine, which is similar to adrenaline, and can trigger chronic stress, heightening the “fight or flight” response, he said.

But with the injection, “the whole cascade reverses,” Lipov said. “The sprouting falls off, norepinephrine falls to normal levels and people are calm and collected.”

Some military doctors have been using SGB for years to treat patients with PTSD and want the procedure to be used more widely to treat the disorder.

Former Navy SEAL Dr. Sean Mulvaney has treated more than 1,000 PTSD patients successfully using SGB, he says on his website. Dakota Meyer, the first living Marine to be awarded the Medal of Honor since the Vietnam War, was one of his patients.

Having an SGB shot “made such an impact on me … I caught myself singing in the shower,” Meyer said in a video posted on Mulvaney’s website.

“So many times, I’ve stood in the shower with my hands against the wall, the shower running over me, thinking … ‘How am I going to get through this day?’” Meyer said in the video.

“I’ll never forget that one moment, the day after I got the block, singing in the shower. Like, ‘Holy smokes, I can’t believe this.’ ”

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