Treat PTSD – With an Injection?

Posted by Jason Van Steenwyk

doctor with needleTreat our returning warriors with a shot.

That’s the logic behind a new treatment for post-traumatic stress symptoms – and at least one clinician is reporting substantial early success.

This isn’t an ordinary flu shot, though. The injection required applies an anesthetic to “numb” a conflux of nerves inside your spine, close to the 7th vertebrae. Basically, it requires a horse needle to penetrate an inch and a half of tissue and inject the anesthetic directly into your spine.

The therapy itself isn’t new. It’s been used in pain management circles since the 1920s, and it’s widely used to treat menopausal symptoms among women. But one scientist, Dr. Eugene Lipov, an anesthesiologist practicing in the Chicago area, has modified the technique and is applying it to help individuals suffering from severe PTSD to control their symptoms.

The Theory

Why does it work? Well, even Dr. Lipov isn’t entirely sure – which is part of why he’s been having trouble receiving funding to expand research and trials. But the theory is this: Traumatic experiences, such as combat, near-death experiences, rapes and the like, are associated with the manufacture of a hormone called Nerve Growth Factor. This causes the runaway development of nerves – specifically in a region of the spine called the Stellate Ganglion.

Historically, scientists have thought that they could control sympathetic symptoms of certain disorders by numbing the nerves in the Stellate Ganglion. For example, scientists have reported some success in helping breast cancer patients control night sweat symptoms, mitigate “hot flashes” in menopausal sufferers, and control profuse sweating of the hands.

Lipov was familiar with the technique in treating sympathetic nervous symptomology in these ailments, and hypothesized that the same logic might be effective in controlling certain symptoms of PTSD.

Is It Safe?

Some military people have viewed the technique with some trepidation. After all, memories die hard, and yes, the government did deliberately infect a number of servicemen with syphilis years ago.

This does not appear to be one of those cases. The treatment has a decades-long track record, and is generally considered safe. Side effects (other than the obvious pain and soreness you would expect when sticking a needle 1 ½ inches into your spine) are extremely rare. Doctors warn against the procedure if you are taking a blood-thinning agent, but that’s true of any invasive procedure. But long-term negative effects in previous applications of the treatment were on the order of 1 in 100,000.

More common side effects include difficulty swallowing and “a lump in the throat.”

Does it work?

It’s too soon to say for sure. An early study, published this year in the American Journal of Psychiatry, suggests that four PTSD patients out of nine reported an immediate and substantial improvement in PTSD symptoms. The problem: There were only nine patients in the study.

Naturally, it will take money to expand the study to a more meaningful sample of PTSD patients. But the government so far isn’t playing ball, according to wired reporter Katie Drummond, who has been following the story for some years already.

The application to PTSD is novel – but did have a full peer-review in the February 2012 issue of Military Medicine, a professional journal by and for the military surgical and medical community.

The study’s authors broadly confirmed earlier findings by Lipov and others, and reported the treatments appeared to be effective at helping mitigate two of the three major symptoms of PTSD – isolation and hyperarousal. There was no real improvement in “re-experiencing,” however. But the study only involved eight patients. There were almost as many doctors (seven) co-authoring the study… and one of them was Lipov.

Alternatives

While it seems counterintuitive at first blush, to treat a psychological ailment with an injection, most of the therapies currently in use aren’t exactly working out great. Other medications – antidepressants, anti-anxiety medications, and the like, can take months to become effective. And cognitive/behavioral therapies – talking it out on a couch – can take many months, with the therapist racking up billable hours all along the way. Even then, existing treatments for PTSD aren’t knocking the ball out of the park.

Cognitive therapy costs thousands of dollars per veteran over time – as do conventional drug therapies. In contrast, a stellate ganglion block treatment takes 10 minutes and costs about a thousand dollars.

Which is one reason why we expect the treatments’ popularity to grow among doctors.

But so far – and taken with the appropriate large grains of salt that such small samples demand  – the treatment appears at least occasionally effective, and provides immediate symptom relief – within hours, claim the Military Medicine studies.

Early indications are that the treatment is even effective with “hard cases.” That is, treatment-resistant PTSD cases that have not been responsive to cognitive/behavioral therapy and pharmaceutical treatments.

But you didn’t expect the easy cases to line up around the block to receive a horse needle in the back, did you?

 

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