More SGB Research Needed: Position Statement

Click here to view or download the PDF version of the CMI position statement.

What We Know: Our Current Understanding

  • The scientific evidence-base for PTSD treatment with SGB is entirely limited to case studies.[1-6]
  • SGB appears to have a “calming effect” and substantially improves quality of life by reducing PTSD symptoms including intense anxiety, hyperarousal, irritability, intrusive thoughts, sleep disturbances, and suicidal ideation.
  • Similar to all medical treatments, the effects of SGB on patients with PTSD are not universal and the degree of response varies from individual to individual.
  • As an FDA-approved procedure that has been used for decades as a pain management treatment, SGB can be safely administered by a trained physician in about 10 minutes.
  • On average, two SGB treatments seem to be needed. Results are almost immediate but sustained outcomes vary from patient to patient.[7]
  • The estimated costs for SGB treatment (i.e., two injections) are $2,000 per patient.[4]

What We Don’t Know: Key Answers Missing

  • What patient characteristics are likely to be associated with positive PTSD symptom relief after SGB treatment?
  • What leads to different levels of PTSD symptom relief after SGB treatment (e.g., none or short-term relief vs. long-term or permanent relief)?
  • How many SGB treatments are necessary to achieve and sustain PTSD symptom relief?
  • By what mechanism does SGB affect PTSD symptoms? Is there one or multiple pathways?
  • What biomarkers may be helpful in determining SGB’s potential mechanism of action in PTSD?
  • What is the likelihood of a placebo or an acupuncture effect accounting for PTSD symptom relief after SGB treatment?
  • How can SGB treatment be combined with other evidence-based therapeutic modalities to achieve optimal results for patients with PTSD?

Consequences of Inaction or Delayed Action

Public Health Implications:

  • Continued escalation of PTSD-related[8-10] depression, substance use and violence.
  • More lives destroyed by PTSD due to inability to work, difficulty maintaining healthy relationships with family and friends, and continued suffering from poor quality of life.[9]
  • Prolonged pain and disability that could be mitigated among predominantly young lives.

Economic Implications:

  • Loss of potentially substantial cost savings associated with PTSD treatment which currently ranges from $6,000 to $30,000 per patient.[9]
  • Increasing the cumulative cost burden of PTSD beyond >$650 billion for service members and veterans.[11,12]
  • Loss of productivity and readiness in the workforce.

References

  1. Lipov EG, Joshi JR, Lipov S, Sanders SE, Siroko MK. Cervical sympathetic blockade in a patient with post-traumatic stress disorder: a case report. Annals of Clinical Psychiatry 2008;20(4):227–228.
  2. Lipov E. Successful use of stellate ganglion block and pulsed radiofrequency in the treatment of posttraumatic stress disorder: a case report. Pain Research and Treatment 2010;2010:963948.
  3. Mulvaney SW, McLean B, de Leeuw J. The use of stellate ganglion block in the treatment of panic/anxiety symptoms with combat-related post-traumatic stress disorder; preliminary results of long-term follow-up: a case series. Pain Practice 2010;10(4):359–365.
  4. Lipov EG, Navaie M, Stedje-Larsen ET, Burkhardt K, Smith JC, Sharghi LH, Hickey AH. A novel application of stellate ganglion block: preliminary observations for the treatment of post- traumatic stress disorder. Military Medicine 2012;177(2):125–127.
  5. Hickey A, Hanling S, Pevney E, Allen R, McLay RN. Stellate ganglion block for PTSD. American Journal of Psychiatry 2012;169(7):760.
  6. Lipov EG, Navaie M, Brown PR, Hickey AH, Stedje-Larsen ET, McLay RN. Stellate ganglion block improves refractory post-traumatic stress disorder and associated memory dysfunction: a case report and systematic literature review. Military Medicine 2013;178(2):e260–e264.
  7. Hickey AH, Navaie M, Stedje-Larsen ET, Lipov EG, McLay RN. Stellate ganglion block for the treatment of posttraumatic stress disorder. Psychiatric Annals 2013;43(2):87–92.
  8. Institute of Medicine. Treatment of Posttraumatic Stress Disorder: An Assessment of Evidence. Washington, DC: The National Academies Press; 2008.
  9. Tanielian T, Jaycox LH, eds. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation; 2008.
  10. Strauss JL, Coeytaux R, McDuffie J, Nagi A, Williams JW Jr. Efficacy of Complementary and Alternative Therapies for Posttraumatic Stress Disorder. VA-ESP Project #09–010; 2011.
  11. Stigliz JE, Bilmes LJ. The Three Trillion Dollar War: The Real Cost of the Iraq Conflict. New York: W. W. Norton & Company; 2008.
  12. Congressional Budget Office. The Veterans Health Administration’s Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans. February 9, 2012.

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