Treating Post-Traumatic Stress Disorder With a Jab to the Neck

Apr. 30, 2010— -- A quick jab to the neck may be all it takes for immediate relief of Post-Traumatic Stress Disorder (PTSD), according to new research from Walter Reed Army Medical Center in Bethesda, Maryland.

Some doctors, however, caution that more research is necessary before the procedure is deemed safe enough for widespread use.

In a study published Friday in the journal Pain Practice, Stellate Ganglion Block (SGB), a ten-minute procedure that applies local anesthetic to a bundle of nerves in the neck, proved an effective remedy for this anxiety disorder, potentially offering an alternative to the pharmaceuticals traditionally used to treat the flashbacks, anger, anxiety, and sleep disturbances caused by PTSD.

Unwilling to take medication for the rest of his life for his PTSD, John Sullivan, 28, a retired Marine Corps Sergeant from Chicago, sought out the experimental treatment from a Chicago-based anesthesiologist, Dr. Eugene Lipov. Lipov is not part of the Walter Reed study.

While the block itself has been used to relieve certain kinds of pain since 1925, Lipov was the first to begin treating PTSD with this injection. He accepted Sullivan as part of a double-blind placebo study he's currently conducting on retired soldiers.

Sullivan was injured by a grenade explosion in 2003 while serving in Iraq. In the years that followed, he would suffer flashbacks, nightmares, and anxiety, but it was not until a year ago that he was diagnosed with PTSD and was prescribed anti-anxiety medication.

"I didn't realize it at first, but I was losing my interest in going out with people, almost becoming a hermit, I wouldn't want to do work, call people... anything," Sullivan said.

But medication and therapy "wasn't working 100 percent," Sullivan said, "I'd take an anxiety pill and then I would be drowsy at work and I'd still be nervous and not want to go out with friends."

The injection, which he received two months ago, "was different," he said, "not painful and the results were within five minutes -- I felt more relaxed and calmed down. It's been great."

Because the study is placebo-controlled, Sullivan does not know if he actually received the block or a placebo procedure, but he felt that "so far it's working."

Neck Jab Provides Relief to Vets With PTSD

Led by Lieutenant Colonel Sean Mulvaney, Friday's report duplicated Lipov's past work with the block through a clinical trial of this treatment in two soldiers -- a 36-year-old white male on active military duty and a 46-year-old Hispanic male whose symptoms began 18 years ago after his service in the first Gulf War.

Both patients, according to the study, "experienced immediate, significant and durable relief" of their symptoms -- a relief that pharmacological treatment had failed to provide them.

After the first treatment, one patient reported that he felt as if "a cloud had lifted" from his mind and that he hadn't "felt this good since high school," researchers write. This relief continued in the months following the injection and under psychiatric guidance, the patient was able to taper off his medication.

Traditional treatment with therapy and antidepressants can take months to relieve PTSD symptoms, and can cause side effects such as impotence, weight gain, and sedation, Lipov said. But the block offers another way -- it works within 30 minutes and does not have those side effects.

The effects can last between six months and a year, and long-term results have been excellent so far, he said. One patient, he reported, has been symptom-free for a year and a half following his second shot.

Though these blocks have been used medically for the better part of a century, Dr. Eugene Viscusi, the director of Acute Pain Management at Thomas Jefferson University said that the procedure "is far from risk free -- including some potentially very dangerous complications."

The safety of the treatment would have to be tested "but these findings are definitely interesting," said Viscusi, and worthy of further research.

How can numbing part of the neck fix a psychological problem?

When a traumatic event is experienced, it leads to an increase in nerve growth factor, Lipov said, a change that leads nerves in the brain to "sprout like flowers."

In one study, he said, they studied soldiers about to take their first jump out of an airplane and found that their nerve growth factor spiked to nearly twice normal levels.

This spike causes nerves to sprout, and this sprouting results in an increased production of adrenaline in the brain, making patients feel anxious. By applying local anesthetic to block a certain nerve group in the neck, Lipov said the nerve growth factor returns to normal and symptoms subside.

In one of his PTSD patients, Lipov noted that trauma centers in the brain would light up in scans when the man was shown violent pictures. After the block, those parts of the brain no longer responded to the trigger.

Testing Continues

Dr. Michael Roizen, chief wellness officer at the Cleveland Clinic, said more data is needed, especially controlled clinical trials, before this treatment could be used more widely.

With his current double-blind study, Lipov hopes to work towards just that kind of data.

"I hope this will eventually become the standard treatment for PTSD. It's quick and effective, only $500 to $1,000."

With so many veterans returning from combat plagued by psychological disorders like PTSD, he said, "I think it's going to be huge in addressing the 'reverse surge' -- all these vets coming back to the country with these psychological problems."