The use of stellate ganglion block in the treatment of panic/anxiety symptoms (including suicidal ideation), with combat-related posttraumatic stress disorder

Abstract

Posttraumatic stress disorder (ptsd) is a chronic anxiety disorder caused by seeing or experiencing traumatic events. The symptoms of ptsd lead to clinically significant distress, functional impairment, and suicide. Although multiple populations suffer from ptsd symptoms, this chapter focuses on military population. Recent wars have led to a large number of military personal having multiple and severe symptoms of psychological distress. This increase has been punctuated by reports of extremely high suicide rate. While advances have been made in understanding and treating this syndrome, barriers to their care continue to exist among military personnel; namely the stigma attached to having a mental health issue and the difficulty finding a treatment regimen that works. This chapter focuses on a veteran who presented with severe ptsd and active suicidal ideations seeking to be treated by cervical sympathetic blockade. His story of previous treatment history, severity of symptoms, and the need to find a clinician outside the conventional military providers demonstrates the urgent need for a system-wide change. The veteran described above was treated by the author with stellate ganglion block (SGB) two days after presenting for care and had resolution of suicidal ideation 30 min following the procedure. He had the SGB treatment repeated one time 16 days after SGB #1. Four years after completing the treatment, the patient was doing well as defined by a marked reduction in psychiatric measures, as well as self-report. The SGB has traditionally been used to treat chronic pain and has recently been reported as a successful treatment of ptsd symptoms by four military institutions (Walter Reed National Military Medical Center, Long Beach (California), Tripler Army Medical Center (Hawaii), Naval Medical Center (San Diego)). Cervical sympathetic blockade involves injecting a local anesthetic next to a group of nerves (ganglion) in the neck and has been used clinically since 1925 with very few side effects. Finally, the neurobiology of SGB is discussed and the future direction of the sympathetic system modulation as a treatment option for ptsd.