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SGB injection for PTSD patient

Presenting Complaint

30 year old presented with a long history of severe PTSD. Symptoms included hypervigilance, always being on the edge, repeated disturbing memories, repeated disturbing dreams, feeling very upset when reminded of a stressful experience from the past, avoiding thinking about stressful experiences from the past, loss of interest in things he used to enjoy, feeling cut off from other people, sleep problems, irritability, angry outbursts, difficulty with concentration and physical symptoms like palpitations and sweating. In addition, patient was not able to concentrate at work, enjoy simple things in life or have a conversation with friends or colleagues.

Previous Investigations/ Treatments

This patient had seen a variety of specialists in the past including psychiatrists, psychologists, and trauma counsellors. He was given a formal diagnosis of post-traumatic stress disorder (PTSD). He tried various treatments including anti-depressants, CBT, psychotherapy and EMDR. He also tried several sessions of TMS and also ketamine infusions. Unfortunately, none of these treatments helped him to any great extent.

Treatment from Dr Krishna at Pain Spa

The patient saw Dr Krishna at his private clinic at the Willow Surgery in Bristol, having researched extensively about the role of SGB in the management of PTSD symptoms. Dr Krishna discussed the treatment in detail and explained all the possible benefits and associated side effects. The SGB was performed under real-time ultrasound guidance at the C6 level with a long-acting local anaesthetic. The injection was also performed at the C3 level to target the superior cervical ganglion, in addition to the SGB. The patient did not feel any immediate benefit and seemed slightly disappointed at the time. However, things started improving after 48-72 hours with improvement in his mood, concentration sleep and various other symptoms.

Patient’s perception of SGB Treatment (in his own words)

Actually, I am well. Well better than I have been in a while anyway! – the most recent procedure has indeed made a significant difference to my life, much more so than the previous two.
I noticed the effects from probably about 48 hours after when I started getting this weird tingling sensation all across my scalp. Then the world started to come alive. Colours became brighter and more vivid, food became more enjoyable and flavours became intensified. It was such a weird experience witnessing this shift as it was happening. It’s not like I went to bed and when I woke up things were different, I could actually see the world becoming more vivid and brighter at the moment. I want to believe it’s either a trigger of neurogenesis, or the release of neurotransmitters, or my brain regrowing parts that had atrophied through depression, who knows but I still get the tingles almost 3 weeks later! It’s a really nice almost healing feeling and I hope it continues.
Since then everything in my life has just felt a little bit easier. Talking to people, making phone calls, doing work. I sleep better and I don’t have an overwhelming sense of dread upon waking anymore. I feel more relaxed in general. I’m not saying my problems are completely cured but they feel a little less heavy and it’s certainly a step in the right direction.

Outcome

It is still early days and we hope that the improvement in this patient’s symptoms will persist over a length of time. However, this is impossible to predict and it is important to note that SGB is not a ‘magic bullet’ and may not be beneficial in some patients. It is important to continue to engage with the mental health team and follow their advice. We will continue to monitor the progress of this patient with PCL-5 scores at 1 week and 3- months post-procedure.

For further information please contact us at clinic@painspa.co.uk. Please click the link below for further details:

https://www.painspa.co.uk/procedure/stellate-ganglion-block/