National Center for Healthcare Advancement and Partnerships
Center for Compassionate Care Innovation
Use of stellate ganglion block as treatment for Veterans diagnosed with PTSD expected to expand
A successful clinical demonstration project led by the Center for Compassionate Care Innovation and VA Long Beach Healthcare System is expected to expand the use of a treatment that can help Veterans who have been diagnosed with PTSD.
Since its inception in September 2017, the clinical staff members at VA Long Beach have treated more than 120 Veterans who have PTSD symptoms with an injection of an anesthetic to a bundle of nerves, called the stellate ganglion, at the base of the patient’s neck. Many Veterans experienced immediate relief after the procedure, and some Veterans benefitted from an additional injection. More than 185 treatments have been successfully completed with no adverse events.
VHA health system specialist and CCI team member, Ms. Christine Eickhoff, said the treatment, called stellate ganglion block (SGB), is being used increasingly to treat Veterans diagnosed with PTSD at other VA facilities. She expects that trend to continue as the CCI team shares what it has learned in terms of best practices, more anesthesiologists are trained on how to administer the treatment, and more evidence about SGB’s effectiveness becomes available.
SGB is not considered an established first-line treatment for PTSD. However, there is growing evidence that SGB may help alleviate PTSD symptoms such as anxiety and feeling hyperalert. SGB appears to calm the “fight or flight” feeling many Veterans experience. It is not known exactly how the treatment works, but according to Drs. Michael T. Alkire and Christopher Reist at VA Long Beach, SGB likely affects the parts of the brain that manage anxiety.
Ms. Eickhoff said SGB is an adjunctive treatment for PTSD—meaning it can be used in addition to the “gold standards” for treating the disorder—such as psychotherapies like cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR).
“Sometimes Veterans have trouble starting CBT or EMDR, they have trouble even getting their foot in the door because their physiological hypervigilance and reactivity is so high,” said Ms. Eickhoff. If that anxiety can be reduced through SGB, the Veteran may be able to proceed with other therapies. Likewise, if CBT or EMDR is not successfully decreasing hypervigilance symptoms, SGB can be explored as an additional treatment in combination with psychotherapy.
SGB has long been used for the treatment of chronic pain conditions, Ms. Eickhoff said, but mental health providers may not know about how effective SGB could be for Veterans diagnosed with PTSD. Publicity, such as a segment on “60 Minutes” featuring VA Long Beach, and more studies will build awareness, she said. In addition, CCI has captured best practices put into place by VA Long Beach so that other VA facilities have a roadmap for how to set up a clinic and the recommended SGB treatment protocol for Veterans diagnosed with PTSD.
While clinicians focus on patient outcomes, CCI is more focused on identifying barriers to bringing treatments into clinical practice, such as the referral process, cost, patient education, difficulty getting to a VA medical center or living in an area where the treatment is not available.
“We’re filling in the remaining unknowns to fully bring this innovative approach to PTSD treatment into clinical practice throughout VHA and increase accessibility for Veterans who may benefit,” Ms. Eickhoff said.
For more information on SGB or CCI, visit va.gov/healthpartnerships.
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Posted November 19, 2020
