Experimental New Control Therapy for PTSD

"When I see a procedure like this, I almost consider it a no-brainer to make it accessible to other people."

"It doesn't involve any extra training and is already done in pain clinics."

"If we can make this accessible, it would be very beneficial."

Psychiatrist Dr. Rebecca Gomez, Royal Ottawa Hospital

There is a procedure called stellate ganglion block (SGB) which involves injecting local anesthetic into a cluster of nerve cell bodies near the base of the neck. The slender needle used to inject the anesthetic is guided by ultrasound. It is a procedure performed routinely in hospitals across Canada in the treatment of complex nerve pain. The treatment is being used in the United States as a therapeutic protocol for veterans affected by PTSD.

 

Dr. Dan James, medical director of the pain clinic at The Ottawa Hospital was persuaded by psychiatrist Dr. Gomez, to experimentally use the process on one of her patients suffering from PTSD who had himself researched the use of SGB. Dr. James had himself heard of the SGB therapy used to treat symptoms of PTSD and was interested. "The stars sort of aligned and the timing was quite perfect", he said.

The procedure took only fifteen minutes to complete, and for the patient who had suffered the symptoms of PTSD for years, its effect was close to immediate. "It was like the volume on the world had been turned down. I had been listening to white noise for years and the white noise was gone. It was this weird sense of peace."

 

The drug wears off after a few hours, but its effect on PTSD symptoms lasts for months. Local anesthesia is injected into the structures providing most of the sympathetic nerve signals to head, neck, arms and part of the upper chest. When the patient displays signs of a condition named Horner syndrome (a patient's face droops on one side) doctors realize the target has been hit.

 

Dr. Gomez speaks of the theory behind the treatment; the local anesthetic acts as a reset button through blocking nerves temporarily that travel from the stellate ganglion to parts of the brain more active in PTSD, decreasing release of stress hormones like norepinephrine or adrenalin. The stellate ganglion is part of the sympathetic nervous system affecting a person's fight or fight response.

 

There is a theory of PTSD being a syndrome where the fight or flight nervous system sticks in the ON position. SGB appears to act like an OFF switch, resetting that response. Dr. Gomez and her colleagues from the Operational Stress Injury Clinic at the University of Ottawa Institute for Mental Health Research and the Royal Hospital were recognized with an award for their case study on SGB involving 30 patients who received the procedure. Survey results received from ten of the participants indicated a significant decrease in symptoms such as sleep disturbances, intrusive thoughts and flashbacks, with patients also reporting a significant decrease in symptoms of depression.

 

About eight percent of Canadians experience symptoms of PTSD, according to a 2021 Survey on Mental Health and Stressful Events from Statistics Canada. First responders and the military are often associated with PTSD, but the syndrome affects a broad segment of society. Symptoms can include unwanted thoughts or dreams, strong physical reactions when reminded of an event, strong negative emotions, and a loss of interest in activities once enjoyed. In addition, PTSD is more common among women than men. Compared to eight percent of men, one in ten Canadian women have symptoms of PTSD.

 

The anesthetic used in the procedure -- bupivacaine -- costs roughly $18 for each injection. Not every patient experiences profound remedial results, however. Of nine patients who undergo SGB, about three will see a significant improvement; three or four will realize some benefit, but not as notable. About two will experience no noticeable benefit. However, up to 80 percent of patients report a 50 percent reduction in symptoms.

 

Possible breakthrough treatment for PTSD   CBS News