Hand-held ultrasound shows soft tissue of the neck during SGB treatment.
I was initially doubtful because studies are largely on young vets with PTSD from war, rather than older people with Complex/Developmental Trauma. However, I had the pleasure of speaking with Dr. Eugene Lipov, who developed the procedure for PTSD. He told me that in his experience “hypervigilance is hypervigilance,” effectiveness depends on individual response, “how much trauma they’ve had and how long they’ve had it,” and with my complex and compounded trauma he felt I had about a 50% chance of success.
The good doctor was right! Each treatment gave my nervous system the opportunity to downregulate or recalculate my threat level. Aside from tinnitus and chronic muscle tension, all other symptoms were dampened. Access to my prefrontal cortex (PFC) increased, energy and spirits rose, and pretty much everything was easier. For about two weeks. This is a fraction of the usual 1-3 month relief.
Symptom Creep and Ongoing Trauma
At about 14 days “symptom creep” came on rapidly and my functionality went down in seemingly equal measure. During the first treatment gap of 35 days, my condition quickly deteriorated until the last two weeks I was near death and very near death. This 2-week pattern continued until my pain specialist came up with another idea.
Thinking back on what Dr. Lipov told me during our phone conversation, I realized that ongoing traumatic events are a significant factor in my short SGB effectiveness window. I would have a better response to SGB if I could focus only on healing my nervous system instead of dealing with continuing trauma. I can’t control most things, but I can avoid some triggering things, and improve the safety of my environment. That has meant major changes in relationships of all kinds. I’ve had to end friendships, put distance between myself and most family members, and winnow out healthcare providers who cannot show compassion and connect at the heart level. It’s difficult and often painful work, but also lifesaving.
I also had to move out of the isolated basement apartment next to a busy road. Now in a cottage with nice neighbors nearby, my nervous system receives cues of safety all day instead of cues of threat.
SGB #6 was a left-sided procedure instead of the usual right. This was due to new info I found at Dr. Sean Mulvaney’s site. He reports that a small number of patients, who respond well to the right side, will respond profoundly to the left. Unfortunately, I was not one of them. We resumed right-sided SGBs.
Fortunately, tho I am a difficult/complex case, the SGB treatments still continue to “build on each other” as others describe. Gradually, my baseline anxiety level has gone down, as has the level of ambient pain. This is a great relief!
Medical Trauma Hiatus = Forward Motion
After two particularly bad experiences with new providers, which heavily triggered me and caused me great dissociation, I determined it best to suspend all medical interactions except those with providers I can trust to not trigger/harm me. I canceled all others, including consults, tests, and screenings, even my dental check-up. I spent 3 months focused exclusively on healing my nervous system as much as possible.
Until that break, I had not realized how much effort I was putting into managing doctor visits, preparing materials and bullet points, building up my courage, and dealing with insurance BS.
Pulsed Radio Frequency Ablation (pRFA) to Prolong SGB Effectiveness
Luckily, my awesome pain specialist offered the opportunity to try Ppulsed Radio Frequency Ablation (pRFA), which is the crucial element for me. SGB #7 and SGB #8 were enhanced with the ablation. Without it the effects last 2-8 weeks. With pRFA I get 8 months of relief! Unfortunately, this combination can be difficult to find, as it is considered experimental. There are just a few case studies and insurance won’t cover it. I paid $1,000 out of pocket for SGB #14 with pRFA.
SGB = Tool, Not Cure
SGB is a wonderful tool, but it isn’t magic and can’t “cure” Complex PTSD. That comes from creating ever safer environments for ourselves, replacing old bad memories with new positive experiences, developing a secure attachment style, and building neural pathways for safe connections.
Good sources of more info about SGB for PTSD:
Dr. Eugene Lipov’s new Stella Center
Pulsed Radio Frequency Ablation (pRFA) Can Prolong SGB Effectiveness
“Successful use of stellate ganglion block and pulsed radiofrequency in the treatment of posttraumatic stress disorder: a case report,” by Dr. Eugene Lipov
“Pulsed Radiofrequency-Enhanced Dual Sympathetic Block for the Treatment of Post-Traumatic Stress Disorder,” Tabitha Block, Jonathann Kuo, Marcel Green
“While first-line PTSD treatment protocols typically include trauma-focused cognitive behavior therapy in combination with pharmacological interventions, only a subset of patients find these treatments adequate for symptom relief or even symptom remission, while many patients with PTSD continue to struggle to manage their symptoms despite seeking care. Surveys of individuals with PTSD have revealed numerous limitations to these conventional methods, including concerns about emotional readiness for treatment, stigma, and logistical issues [4]. Similarly, many traditional pharmaceutical interventions have a slow onset of action and can pose serious side effects, leading to high rates of poor compliance with such treatment protocols [4].
Stellate ganglion blocks (SGBs) have been recently demonstrated to provide significant and long-lasting PTSD symptom relief, including improvements in anxiety, negative mood, and hyperarousal [5-10]. SGB is a specialized sympathetic nerve block in which a local anesthetic such as bupivacaine is injected into the region of the cervical sympathetic ganglion. The procedures are typically repeated on the contralateral neck to enhance their therapeutic potential. When used in conjunction with trauma-focused psychotherapy, SGBs have been shown to have a 70-80% success rate in treating PTSD symptoms [5-10]. Furthermore, there is a significant evidence base indicating that SGB may provide durable and lasting symptom relief for at least a subset of PTSD patients…However, despite the high success rate and strong safety profile of SGB and DSB for PTSD, there is a subset of patients who, while experiencing a significant improvement in symptoms initially, may continue to suffer from the condition. Implementing modifications to the traditional SGB procedure that extend the length of its clinical benefits would have profound implications for this subset of PTSD patients.
In this case report, we discuss sustained positive clinical outcomes observed in one PTSD patient following treatment with a cervical sympathetic blockade at the C6 level followed by the C4 level targeting superior cervical ganglion, thereby displaying the enhanced efficacy of DSB with the addition of pulsed radiofrequency (PRF) at C6 and C4 levels in at least a subset of PTSD patients.”
Other Uses for SGB