The Most Promising PTSD Treatment You’ve Never Heard Of: SGB injection

July 4th, 2023
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Not all stress is bad. A moderate level of stress can be a motivator and can enhance how we perform complex tasks. However, too much stress, the kind that comes from unaddressed trauma, impairs performance. When stress is at peak levels, we literally lose sleep. Our ability to concentrate is affected, in both the short and long term.

To really appreciate how much stress can impact our ability to take in new information, think about it like this. Just for a moment, imagine that you had to go see your doctor to get test results on whether or not you have a serious medical diagnosis that could greatly affect your quality of life. There is a reason why your doctor’s office might recommend that you bring a trusted family member or friend to your appointment. If the news is not good, it is common to become overwhelmed by stress, which can then cloud our ability to hear anything else a doctor says, including crucial instructions about next steps.

Many mental health providers like myself have worked with patients who are living in a chronic state of “survival mode,” where decisions are made in a “fight or flight” context. Sometimes we can see it on their face, like when we see them constantly scanning the room for threats. And sometimes, when we sense they are not fully with us in the present moment in therapy, it’s because they’re not – they are paying attention to something else in their mind’s eye that we can’t see, often related to a past trauma.

When our patients are in the wrong mind state, when they are overrun with adrenaline and unable to calm down, they are not prepared to receive and integrate psychological insights. For many years, before I learned about stellate ganglion block, I did my best to help my patients using empirically supported therapies, while many of them were in a state of what I call “chronic threat response.”

Once we understand the impact of high levels of anxiety on how our patients can engage in therapy, we can see how reducing their level of anxiety could change everything about their experience in therapy. Stellate ganglion block (SGB) involves injecting a common anesthetic medication into a cluster of nerves in the neck, which seems to restore calm to an over-active fight or flight system. SGB, as an intervention for trauma symptoms, arose from a line of thought that views PTSD as a largely biological condition with psychological and emotional components maintained by a damaging shift in normal biological functions.

Psychological trauma exposure results in a biological injury where people become stuck in “fight or flight” mode—potentially for years, or even decades. While PTSD has often been described as an “invisible wound,” it is in fact visible in certain types of brain scans. And it is not only visible, it’s treatable. Dr. Michael Alkire, the Chief of the Anesthesiology Service within the VA Long Beach Healthcare system, translates his 2015 study findings as follows: “There are changes in the brain that can be related to changes in symptoms that relate to what SGB does to brain functioning. This early result – based on a small sample – suggests that the changes in symptoms were related to the changes in amygdala/hippocampal functioning induced by the SGB.”

SGB has been used to successfully treat thousands of military service members suffering from symptoms associated with PTSD (Lynch, 2020). Within the civilian sector, Dr. Eugene Lipov and I have co-treated approximately 50 patients to date, as part of countless others he has treated prior to our collaboration. With SGB and therapy together, our patients have shown a much greater ability to apply psychological insights and maintain the gains of a successful course of therapy. This is a new model for trauma care—the fusion of biological and psychological care among allied healers.

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At Pain Spa, Dr Krishna is very experienced in managing PTSD patients with SGB injections. Dr Krishna has successfully performed hundreds of Stellate Ganglion blocks. Please contact us for further details if you are interested in having a consultation with Dr Krishna.