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If injected into a cluster of nerves located in the neck, just a few milliliters of local anesthetic might be enough to block the symptoms of post-traumatic stress disorder (PTSD).
The shot, called stellate ganglion block (SGB), could transform the lives of the 20 percent of veterans coming back from war with PTSD, as well as civilians who suffer from post-traumatic stress.
The military is spending $2 million to test whether SGB is actually effective as a treatment for PTSD, in the first large-scale randomized control research study.
The anesthetic inhibits the excess nerve growth responsible for triggering chronic stress. Theoretically, this reboots the fight or flight instinct and potentially blocks the symptoms of PTSD, co-principal investigator Kristine Rae Olmsted of RTI International told Independent Journal Review.
The anecdotal evidence in favor of SGB is compelling. When the shot is effective, patients report improvement in less than 30 minutes. Some soldiers have such faith in SGB that they call it the “God block,” said Dr. Eugene Lipov, who pioneered the SGB treatment for PTSD and has used it to treat over 500 patients.
“They call it that because it changes their lives,” Lipov said.
One of the first patients Lipov treated suffered from severe PTSD after serving in Iraq, where the soldier's helicopter was shot down and where he had to shoot a 10-year-old suicide bomber.
“When I met him, he was very tense, and he talked about how there were always images just outside his view,” Lipov told IJR. “Right after the procedure, he looked calmer, he was smiling, he said he felt so more relaxed. It was amazing.”
The soldier is now off medications for PTSD and doing well, according to Lipov. However, Rae Olmsted warned the shot is not a cure, even if it works.
“We have never, ever billed the stellate ganglion block as a cure,” Rae Olmsted said. “PTSD is really a holistic disorder — it involves not only the physiological arousal but also emotions, cognitions, family, and personal interaction. Simply treating the physical symptoms does not get at the whole of what PTSD really is.”
Ideally, the STB would be followed by other, more standard treatments for PTSD, such as talk therapy or medication, Rae Olmsted said.
But if RTI isn't able to recruit enough volunteers, that will likely be a moot point. This study — the first of its kind — is the “foot in the door” for SGB to gain acceptance in the wider medical community, Rae Olmsted said.
Less than a handful of doctors use the stellate ganglion block to treat PTSD. And of that handful, most are connected with the Special Forces, Lipov said. The wider medical community is reluctant to endorse the treatment without evidence from a controlled study.
This study is key to changing that. But after two years, the study has recruited 48 people. Its goal is 240.
Rae Olmsted attributed the slim numbers to people's unwillingness to risk the 33 percent chance of receiving a placebo:
“These people are in extraordinary pain. They want relief now. But, on the flip side, if we aren't able to show with a gold standard, scientifically valid study that the treatment is effective, the procedure could potentially go away. Nobody would ever have access to it other than the very elite of the Special Forces. That is the true danger.”
Along with recruitment, the study faces the problem of the placebo itself, which cannot replicate the physical signs of the shot. Recipients may be able to know whether they received the placebo or SGB, although 35 to 50 percent of patients still guess wrong in the face of visible evidence, Rae Olmsted said. She explained the problem:
“We're doing the best we can to control for that, but there is no practical way to control for a patient being able to look at themselves in a mirror.”
She also added that researchers will be able to compensate for the influence with statistical analysis, but Rae Olmsted said there is “a distinct possibility it could influence our research.”
The study is currently scheduled to conclude its research by the end of Feb. 2018, though RTI has applied for an extension until Feb. 2019.