By Taylor Knopf
A procedure historically used to treat pain could also be used to help people with post-traumatic stress disorder, according to a recent clinical study by Research Triangle Park-based RTI International.
Researchers found that a treatment called stellate ganglion block (SGB) improved symptoms of PTSD in their study participants.
The treatment involves an injection of local anesthetic to the stellate ganglion, located in the neck. The stellate ganglion is part of the sympathetic nervous system which controls the body’s “fight or flight” response.
SGB is a procedure used to treat nerve injuries or pain in the upper body. It’s a 30-minute procedure with little to no recovery time.
Some experts were skeptical when the study was announced in 2015 because the only evidence of SGB working to treat PTSD was anecdotal. Some doctors had been using it on a limited basis to treat soldiers with PTSD.
“Nobody knows how it works, we now just know that it does,” said Kristine Rae Olmsted, behavioral epidemiologist at RTI and co-investigator on the study.
Widespread study
RTI International received a $2 million grant from the U.S. Department of Defense to conduct the three-year study with test subjects spread across three sites: Womack Army Medical Center in North Carolina; Tripler Army Medical Center in Hawaii; and Landstuhl Regional Medical Center in Germany.
Study participants were given two SGB injections, one at the beginning of the trial and the other two weeks later. Their PTSD symptoms were assessed by psychiatrists using the Clinically Administered PTSD Scale (CAPS-5), a questionnaire focusing on measuring PTSD symptoms, the level of distress and how their symptoms may affect functioning. Researchers administered the questionnaire just before the study began and again after eight weeks to measure improvement.
The CAPS-5 is considered the “gold standard” for PTSD assessment because it’s administered by a trained physician. There are straightforward questions aimed at measuring the symptoms of PTSD, such as, “Do you have nightmares?”
Rae Olmsted said the value of this test is the ability of the trained professional to ask more probing follow-up questions.
The study also included a placebo control group that received injections of saline. All told, 108 active-duty military members participated in the study. Those in the treatment group reported much more relief from their symptoms than those in the control group.
Though all the participants were military members, Rae Olmsted said that not all had experienced combat-related trauma. Some had other types of trauma, such as sexual assault or a car crash. She found that SGB treatment worked to relieve symptoms of PTSD regardless of the type of trauma.
Further study needed
This was the first clinical study on SGB treatment for people with PTSD, and a lot of questions remain.
“The degree to which it takes away the symptoms altogether or it simply lessens the biological response to them is an excellent question and one that we really haven’t studied yet,” Rae Olmsted said.
She is waiting on two grants from the U.S. Army to study this treatment further. She plans to conduct an even bigger study and collect new data.
That study will answer questions such as: How long does the average treatment last? And how many people will need more than one injection?
The second grant will be used to do secondary analysis of the initial study to answer more nuanced questions. For example, Rae Olmsted wants to know whether the SGB treatment works differently for people who have experienced PTSD symptoms longer than someone with more recent trauma?
Rae Olmsted said this study has been a “labor of love.” She is passionate about finding new treatment options for people with PTSD like her father, a Vietnam War veteran.
Current treatment options, such as talk therapy and exposure therapy aren’t enough, she said.
Removing stigma
There is a lot of stigma around mental health in the military. Rae Olmsted encountered this in the follow-up interviews with study participants and their families as well. She said many reported feeling less stigma associated with the SGB injections than going to talk therapy for PTSD.
“It was not entirely unexpected, but it was a very interesting finding,” she said. “With stellate ganglion block, there’s this possibility of more people being willing to go get the treatment, simply because they believe there’s less stigma associated with the medical treatment.”
There could also be a time element at play. Therapy requires a more regular time commitment from a patient. With the SGB treatment, some patients could find significant relief from just one treatment.
“I had a very radical change in feeling the first day,” said one study participant in a press release announcing the trial results. “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.”
Other patients require several injections to find relief, Rae Olmsted said. She hopes to find more answers in the follow-up studies.
How we reported this story:
- Followed up on press release and past reporting
- Interviewed one of the lead researchers
- Read the featured research and related studies
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—There is a lot of stigma around mental health in the military.
If that is so in an organization of command, command must be permitting it.