Oct 18, 2019
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Hello:

New to this forum. I am a board certified Pain Medicine MD.

I have been seeing patients that are interested in stellate ganglion blocks (cervical sympathetic chain) for PTSD, depression, anxiety, etc.
Most of these patients found my practice due to the specificity/complexity of this procedure. Apparently, a '60minutes' CBS piece and a Podcast has sparked interest in this procedure for the aforementioned conditions.

I have done my due diligence and cannot find literature supporting SBGs for these indications, nor does insurance cover this clinical benefit. Subsequently, have offered patients; TMS (transmagnetic therapies) with a psychiatric group, acupuncture, and neuropathic medications. But mainly I turn them away...

I was just wondering what the forum members experience and/or understanding of SGBs for PTSD and what pathological mechanisms are hypothesized? thanks for your comments and input. cheers
 

reca

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Jan 9, 2017
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The data was published two days ago in JAMA Psychiatry, you can read it here. I don't know of any places which offer it clinically, just the VA's which were researching it.

If I had to guess about the mechanism, maybe by working as a longer term beta blockade?
 

wolfvgang22

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Jun 15, 2004
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It is unfortunate that SGB is being hyped up for PTSD so much online and on television at this early juncture. I've had a few veterans express dissatisfaction and disgust that the VA is not providing SGB already. To be fair, these same folks are smoking weed like there is no tomorrow, seeking relief from that instead of doing the difficult work of therapy.

The article in JAMA Psychiatry on November 6th isn't actually all that impressive to me, showing only moderate improvement in PTSD at 8 weeks. I'm concerned this study isn't very generalizable since only 113 active duty military members were the population, also for this short duration of time.
I'll be more interested when they complete the proposed year long study with a larger and more diverse population. Until then, I consider it the flavor of the month. Most likely it will end up like vagal nerve stimulation in usage for depression - too expensive, too inconvenient, too many adverse events, and not helpful enough to justify use in most patients.
 
OP
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Oct 18, 2019
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Attending Physician
The JAMA study is very preliminary. Plus, it doesn't address possible side effects of the SGB; like VT from bundle branch blocks, decreased diaphragmatic function ( several hours), Horner's syndrome, etc. These risks need to be addressed in the context of long term clinical benefits ( BTW 8weeks seems very transient). Thanks for the input...
 
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sluox

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Jan 4, 2002
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I want Medicaid to reimburse $3000 per block and bankrupt the ****ing state. I'm not even ****ting you at this point.
 

wolfvgang22

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I want Medicaid to reimburse $3000 per block and bankrupt the ****ing state. I'm not even ****ting you at this point.
:rofl: :rofl:
 

Bartelby

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Mar 15, 2007
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There is a relatively recent VA evidence brief here: Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD) - VA Evidence Synthesis Program Evidence Briefs - NCBI Bookshelf

"Emergence of an intervention’s first randomized trial is always a highly anticipated event. For SGB, however, findings from its first randomized trial for PTSD proved to be disappointing. In uncontrolled, unblinded, retrospective case series, SGB for PTSD had high rates of rapid clinical improvement in PTSD symptoms (70% to 75%). In the RCT, the range of mean percent PTSD improvement after one round of SGB was 5.4% to 14.7%, and was 12.1% to 21.2% after the second round, which was no better than an injection of saline. "

Looking through the evidence (including the newly published JAMA Psychiatry article) I would consider SGB for PTSD to be investigative at this point, not an evidence-based treatment.
 

sluox

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Jan 4, 2002
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There is a relatively recent VA evidence brief here: Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD) - VA Evidence Synthesis Program Evidence Briefs - NCBI Bookshelf

"Emergence of an intervention’s first randomized trial is always a highly anticipated event. For SGB, however, findings from its first randomized trial for PTSD proved to be disappointing. In uncontrolled, unblinded, retrospective case series, SGB for PTSD had high rates of rapid clinical improvement in PTSD symptoms (70% to 75%). In the RCT, the range of mean percent PTSD improvement after one round of SGB was 5.4% to 14.7%, and was 12.1% to 21.2% after the second round, which was no better than an injection of saline. "

Looking through the evidence (including the newly published JAMA Psychiatry article) I would consider SGB for PTSD to be investigative at this point, not an evidence-based treatment.

I think it's absolutely fascinating that so many of these treatments have such a dramatic placebo effect. And I don't know how or even if we could exploit it for real therapeutic gains.
 

clausewitz2

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Oct 13, 2008
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I think it's absolutely fascinating that so many of these treatments have such a dramatic placebo effect. And I don't know how or even if we could exploit it for real therapeutic gains.
Like E. Fuller Torrey said, if there was a way we could reliably induce it, the "Edifice Complex" (I am going to see a Doctor in a Big Time Hospital) would be one of better interventions.
 

downwithDTB

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Sep 21, 2015
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I think it's absolutely fascinating that so many of these treatments have such a dramatic placebo effect. And I don't know how or even if we could exploit it for real therapeutic gains.
You drill holes in people's brians and stick metal in and decide that you don't need to bother with placebo controlled trials because the placebo of not turning on the device is so damn good you can't beat it.

Make I should start a homeopathic ketamine clinic!