National Center for Healthcare Advancement and Partnerships
Center for Compassionate Care Innovation
Experiencing a life-threatening event, such as combat, can lead to developing posttraumatic stress disorder (PTSD). According to Department of Veterans Affairs (VA) data, Veteran rates of PTSD range from 11% to 30%, depending on the service era. In collaboration with experts at VA hospitals, the Veterans Health Administration (VHA) Center for Compassionate Care Innovation (CCI) is exploring the use of two promising treatment options that may help Veterans counter the effects of PTSD: hyperbaric oxygen therapy (HBOT) and stellate ganglion block (SGB).
Hyperbaric oxygen therapy (HBOT)
In a small-scale project, four VA medical centers (VAMCs) are using HBOT to relieve PTSD symptoms. HBOT uses pressure to increase the amount of oxygen in the body’s cells as patients sit or lie down inside a special chamber. HBOT is known to speed up the healing process for certain conditions, although the extent to which HBOT helps with PTSD symptoms is not known.
Dr. River Smith, a psychologist at the Eastern Oklahoma VA Healthcare Center, said that randomized controlled trials on HBOT for PTSD are lacking, but there are small studies that suggest it might be helpful for people with PTSD symptoms. Current research suggests that some patients’ stress symptoms decrease following HBOT.
She added that “gold-standard treatments” for PTSD symptoms, such as talk therapy and prolonged exposure therapy, show good results for most Veterans, and VA is always looking to provide the best possible care to all Veterans. “It is important for VA to be a leader in identifying other treatments for Veterans who may not improve following these gold-standard treatments. This is why projects like HBOT are so important,” continued Dr. Smith.
Dr. Paul Rock, director of the Center for Aerospace and Hyperbaric Medicine at Oklahoma State University’s Center for Health Sciences, said that the HBOT project is working well.
has been very gratifying that the majority of the Veterans who we have treated to date in this project have been able to finish the treatment and felt that they got relief from it,” he said.
Stellate ganglion block (SGB)
CCI has been working with the staff at the Long Beach VAMC to learn how SGB can be used to treat PTSD symptoms. VA data shows that, during 2018, SGB was used to treat Veterans with PTSD at 11 VAMCs. At Long Beach VAMC, more than 50 Veterans have gotten SGB for their PTSD symptoms since late 2017.
At most VAMCs with a pain clinic or pain rehabilitation program, the SGB procedure is used to treat chronic pain conditions. During the treatment, a shot of powerful numbing drugs is given to the patient at the base of their neck, where the nerves that make up the “stellate ganglion” are located. SGB is generally safe, but serious complications can occur. Referrals for SGB depend on multiple factors, and not all VA locations are able to provide SGB, which requires special medical equipment and staff.
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.
Veterans diagnosed with PTSD who have received an SGB often report feeling better right away. Some said that, because their PTSD symptoms were better, they could go to talk therapy sessions and try other treatments that had not worked in the past. Veterans may find more success with “gold-standard treatments” when they feel better and less anxious.
It is not known exactly how SGB works. According to Drs. Michael T. Alkire and Christopher Reist at the Long Beach VAMC, SBG likely affects the parts of the brain that manage anxiety, which results in people feeling less tension and hyperalert. Drs. Reist and Alkire are providing SGB to Veterans with severe PTSD symptoms as a clinical (non-research-related) service.
During the past two years, a large placebo-controlled trial funded by the Department of Defense looked at the effectiveness of SGB for treating PTSD symptoms. A placebo is a harmless substance or procedure that has no healing effect but looks and feels like the real treatment. Research studies that use a placebo control group to compare to the group receiving the treatment are critical to understanding how effective the treatment is. The study is now complete and the results are highly anticipated.
“All of our treatments need to be held to the highest standard of evidence,” Dr. Reist said. “If the study shows that SGB helps the symptoms, the use of SGB could explode. If this trial fails to show that SGB is superior to placebo treatment, I don’t think SBG will go away, because there’s still such a positive response from Veterans who find it to work.”
SGB was featured in June 2019 on “60 Minutes,” and Dr. Alkire spoke on the show. You can watch the video at cbsn.ws/2IMjLHL.
If you or a Veteran you know is interested in SGB treatment, you can view an informational video online at bcove.video/2GiMEsl and speak to your local VA provider for more details.
VA is the leader in PSTD treatment for Veterans
VA is the world’s leading organization for research and education on PTSD and traumatic stress. VA’s National Center for PTSD monitors new research and shares information quickly to provide Veterans with safe and effective treatments. Visit www.ptsd.va.gov for information about PTSD and its treatment.
VA is building a proactive and personalized health care system that honors Veterans’ service and empowers them to achieve their greatest level of health and well-being. VA care is both patient centered and patient driven. Veterans with questions about PTSD treatment are encouraged to talk with their VA health care providers to learn about available treatment options. VA-enrolled Veterans can contact their provider by secure message through My HealtheVet, by calling their provider’s office, or by making an in-person appointment.
For more information about CCI’s work, please visit www.va.gov/HEALTHPARTNERSHIPS/CCIMission.asp.
Posted August 9, 2019