Study will test neck injections to combat PTSD

It is interesting that a shot may be the answer to turning off intense emotions. Not sure I would want to test this new procedure out. What do you think?

By Gidget Fuentes - Staff writer
Posted : Monday Dec 26, 2011 11:41:48 EST

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SAN DIEGO — After seeing promising results with an innovative treatment for post-traumatic stress disorder, a group of Navy doctors in San Diego hopes a new study will show a shot in the neck that quiets nerves could bring quick, lasting relief to suffering combat vets.

In a pilot study at Naval Medical Center San Diego, 42 active-duty service members will get injections to block or turn off nerves from transmitting triggers that can cause anxiety, hyperarousal or other symptoms of PTSD. Such nerve blocks, much like basic pain management treatments first done in 1925, typically bring relief in a few days, if not several hours, and in the weeks or months after the procedure.

The study, funded by the Navy Bureau of Medicine and Surgery, uses a stellate ganglion block, or SGB. The treatment involves injecting an anesthetic into the stellate ganglion — a bundle of nerves in the neck — which blocks pain signals in the sympathetic nerve system from reaching the brain.

So far, more than 20 patients diagnosed with PTSD have begun the voluntary three-month program, which involves two or three injections of either the real treatment or a placebo, said Capt. Anita Hickey, an anesthesiologist and director of Pain Research and Integrative Medicine at the medical center.

The procedure lasts a half-hour for patients, who in most cases are sedated or receive a topical anesthetic in the neck. An X-ray and, in the case of the San Diego study, an ultrasound machine guide the proper placement of the needle and direct the anesthetic to the targeted spot, Hickey said. The treatment includes checkups at one week, one month and three months after the initial shot, with possible subsequent injections of either the placebo or the anesthetic.

‘Rebooting a computer’

Research shows an SGB injection “does have an effect on the sympathetic nervous system in the brain,” said Hickey, who has used nerve blocks in pain management. She described the treatment as “rebooting a computer,” with most patients seeing reduced PTSD symptoms.

The study team hopes to present its findings in May at an American Psychiatric Association meeting and ultimately get more funding for continuing research and larger clinical studies. An article Hickey co-wrote about the effects of SGB treatment on eight combat vets will be in the February issue of Military Medicine, the Journal of the Association of Military Surgeons of the United States.

The Navy’s study takes a page from Chicago anesthesiologist Dr. Eugene Lipov, who in 2008 first used the treatment for PTSD sufferers. Lipov, who so far has used the treatment on 30 combat vets, unsuccessfully tried four times to get Defense Department funding for a larger clinical trial, but he now provides the $1,000 treatment to patients partly funded through donations.

Lipov, who with Hickey co-wrote an earlier paper about the stellate ganglion block, said the treatment eases symptoms and can reduce emotional reactions to trauma without erasing the memory.

The treatment shows promising results, a Navy psychiatrist involved in the trial said.

“We do see some benefits at one week. People are more calm, are having fewer nightmares, are able to do more things,” said Dr. Robert McLay, Naval Medical Center San Diego’s mental health research director and psychiatrist who works with troops with PTSD.

McLay, an admitted skeptic, is excited about the treatment. “I think it potentially could really change the thinking in some respects with responding to PTSD,” he said.

Popular treatments range from medication and counseling to virtual-reality exposure and even alternative therapies such as yoga and art. But as the Iraq and Afghanistan wars wind down, with as many as one-quarter to one-third of combat vets suffering from PTSD, officials expect to see larger caseloads.

However, defense health officials told a Bethesda, Md., conference this month that fewer than half of PTSD patients are helped by medications and psychotherapy. Lipov said he has seen 80 percent success among his veteran patients so far, but he acknowledged further study will refine the treatment and help doctors better learn which patients and symptoms are helped the most.

Medical experts say the complexity of PTSD, how it affects different patients, and lack of understanding about how the brain works all add to the difficulty of treating — if not curing — the disorder. Combat veterans can suffer nightmares, headaches, depression, anxiety and isolation.

PTSD patients “by their very nature are very jumpy, very hesitant to jump into things,” McLay said. “We’ve actually been getting more volunteers for a shot in the neck ... than coming in and having to meet me twice a week to talk about their trauma.”

Dr. Maryam Navaie, a San Diego research consultant who’s worked with Hickey and Lipov, said SGB treatment requires a shorter commitment, so it’s easier for the vets. “Compliance is 100 percent,” said Navaie, compared to 30 percent to 40 percent for those who are prescribed medications.

That ease and fast relief appealed to Aviation Structural Mechanic 1st Class Christopher Carlson, who retired in 2010 after multiple deployments in a 20-year career that included at-sea tours. Carlson said he subsequently was diagnosed with PTSD after getting worsening bouts of cold sweats, disrupted sleep, anxiety and severe nightmares “that seemed almost real.”

He was prescribed medications, “but really nothing seemed to be working,” he said, and his struggles sidetracked him from getting good employment after he retired in Norfolk, Va., and moved to Chicago. He drank more, was depressed and got more forgetful; he and his wife, who have four children, divorced.

On a fluke, someone told him about Lipov’s treatment. Desperate for relief, he volunteered.

“It seemed like it was a miracle cure,” he said. “It changed my life.”

After his initial improvement seemed to wane a few months after the first injection, Carlson got a second treatment and noticed “night and day” changes.

“My mind is a lot clearer, and I’m sleeping better,” he said Dec. 14. “My emotions are a lot better.”