SGB Treatment

SGB Description


  • SGB is a minimally-invasive, FDA-approved pain management procedure in which a local anesthetic is applied to the stellate ganglion.
  • The SGB procedure can be safely administered with minimal risk in about five to ten minutes with almost immediate results.

Figure 1. Illustration of the SGB Procedure

Stellate Ganglion Block Procedure

Dr. Lipov explaining the use of SGB to treat PTSD

 

SGB Success Stories


Click here to view or download the PDF version of this webpage.

Profile of Patients Treated by SGB for PTSD

  • Number of patients treated with SGB: 83 (31 veterans, 30 women and 22 men)
  • Average age: 40 years (range: 21–71 years)
  • Average number of SGB treatments: 1.6 (range: 1–7)

As with any therapy, results vary from patient to patient, but PTSD symptom relief has been shown to last months or years with SGB among many patients treated by Dr. Eugene G. Lipov, CMI’s Medical Director, who discovered this treatment approach.

Patients Treated with SGB for PTSD: A National Overview, 2007–2013

Patients Treated with SGB for PTSD

Life before SGB Treatment

Commonly Experienced PTSD Symptoms:

  • Anxiety
  • Panic attacks
  • Hypervigilance
  • Avoidance
  • Flashbacks
  • Nightmares
  • Insomnia
  • Depression
  • Paranoia
  • Alcoholism
  • Irritability
  • Suicidal thoughts
  • Eating disorders
  • Dissociation
  • Fear

Little to No Relief from Medications or Therapies:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Non-SSRI antidepressants
  • Sleep aids
  • Adrenergic agents
  • Benzodiazepines
  • Anticonvulsants
  • Behavioral therapy
  • Psychotherapy
  • Group therapy
  • Electroconvulsive therapy
  • Inpatient PTSD programs

Life after SGB Treatment

  • Relieved anxiety
  • Sleeping through the night
  • Reduced or eliminated flashbacks
  • Decreased social phobia
  • Improved relationships with family and friends
  • Increased energy, elevated mood, restored confidence in the future
  • Discontinued alcohol use
  • Eliminated suicidal thoughts
  • Discontinued use of PTSD-related medications
  • Discontinued or minimized ongoing therapy for PTSD
  • Discontinued use of sleep aids
  • Became gainfully employed
  • No longer considered medically disabled due to PTSD

Profile of Veterans Treated for PTSD

  • 31 veterans: 1.7 average number of treatments (range: 1–3)
  • Average age: 37 years (range: 23–63 years)

Selected Testimonials

  • “I was at the end of my rope. I was ready to commit suicide. The procedure is so simple and the result is so great. I get up in the morning and feel rested. My attitude is changed. It’s really a blessing to get up in the morning and face the world.” – Patient R.S., McHenry, Illinois
  • “I was in this deep depression, hearing things, always looking out windows or under doors. But now all this stuff isn’t affecting me. I feel so much better.” – Patient C.C., Lombard, Illinois
  • “I can sleep through the night without having panic attacks and waking up with cold sweats and screaming. I can go and function.” – Patient J.S., Chicago, Illinois
  • “A huge weight lifted off my shoulders almost immediately. I don’t carry a weapon anymore nor do I look over my shoulder in crowded places. That’s huge for me. I’m noting new things every day and so are my wife and kids. I’m actually thinking about the future again.” – Patient E.F., Royal Oak, Michigan
  • “[SGB] erased the past two years [and] the feelings I came home with. It’s allowed me to get back to doing a lot of the things that I couldn’t do when I first came back from Iraq. I feel calmer, I’m sleeping well, and I’m not worried about going out in public.” – Patient J.B., Peoria, Illinois
  • “The effects were within the first few days and it was tremendous. My interests are returning. I don’t have any nightmares, which is nice, which means I can sleep. I’m a little more confident about the future. It all sort of steam rolls to a better situation.” – Patient J.R., Fort Worth, Texas
  • “Last night we went out to dinner and it was the first time I was able to enjoy [my wife’s] company without worrying about who’s walking in the door, what’s this person doing.” – J.P., Sartell, Minnesota

Profile of Women Treated for PTSD

  • 30 women: 1.6 average number of treatments (range: 1–4)
  • Average age: 41 years (range: 21–59 years)

Selected Testimonials

  • “It’s a completely different feeling when you can actually control your own life again.” – Patient from Elgin, Illinois
  • “My anxiety and emotional distress issues have gone away.” – Patient from Bolingbrook, Illinois
  • “I’m feeling much less anxious after the last shot.” – Patient from Bolingbrook, Illinois
  • “I feel like I have more energy and my head feels more clear.” – Patient from Ballwin, Missouri
  • “My sleep, mood, and enjoyment of life have improved.” – Patient from Lombard, Illinois
  • “I feel good and I’ve been doing well.” – Patient from Portsmouth, Virginia

Ken Scholes’ Testimonial

Jason Brown’s Testimonials

Raleigh Showens’ Testimonial

Jeremy Rogers’ and Raleigh Showens’ Testimonials

Additional videos about SGB and patient testiomonials are available here

 

Need for More Research


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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