Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms
Authors: Kristine L. Rae Olmsted, Michael Bartoszek, Sean Mulvaney, Brian McLean, Ali Turabi, Ryan Young, Eugene Kim, Russ Vandermaas-Peeler, Jessica Kelley Morgan, Octav Constantinescu, Shawn Kane, Cuong Nguyen, Shawn Hirsch, Breda Munoz, Dennis Wallace, Julie Croxford, James H. Lynch, Ronald White, Bradford B. Walters
Journal: JAMA Psychiatry (2019)

<h3>Importance</h3> This is the first multisite, randomized clinical trial of stellate ganglion block (SGB) outcomes on posttraumatic stress disorder (PTSD) symptoms. <h3>Objective</h3> To determine whether paired SGB treatments at 0 and 2 weeks would result in improvement in mean Clinician-Administered PTSD Scale for<i>DSM-5</i>(CAPS-5) total symptom severity scores from baseline to 8 weeks. <h3>Design, Setting, and Participants</h3> This multisite, blinded, sham-procedure, randomized clinical trial used a 2:1 SGB:sham ratio and was conducted from May 2016 through March 2018 in 3 US Army Interdisciplinary Pain Management Centers. Only physicians performing the procedures and the procedure nurses were aware of the intervention (but not the participants or assessors); their interactions with the participants were scripted and limited to the 2 interventions. Active-duty service members on stable psychotropic medication dosages who had a PTSD Checklist–Civilian Version (PCL-C) score of 32 or more at screening were included. Key exclusion criteria included a prior SGB treatment, selected psychiatric disorders or substance use disorders, moderate or severe traumatic brain injury, or suicidal ideation in the prior 2 months. <h3>Interventions</h3> Paired right-sided SGB or sham procedures at weeks 0 and 2. <h3>Main Outcomes and Measures</h3> Improvement of 10 or more points on mean CAPS-5 total symptom severity scores from baseline to 8 weeks, adjusted for site and baseline total symptom severity scores (planned a priori). <h3>Results</h3> Of 190 screened individuals, 113 (59.5%; 100 male and 13 female participants; mean [SD] age, 37.3 [6.7] years) were eligible and randomized (74 to SGB and 39 to sham treatment), and 108 (95.6% of 113) completed the study. Baseline characteristics were similar in the SGB and sham treatment groups, with mean (SD) CAPS-5 scores of 37.6 (11.2) and 39.8 (14.4), respectively (on a scale of 0-80); 91 (80.0%) met CAPS-5 PTSD criteria. In an intent-to-treat analysis, adjusted mean total symptom severity score change was −12.6 points (95% CI, −15.5 to −9.7 points) for the group receiving SGB treatments, compared with −6.1 points (95% CI, −9.8 to −2.3 points) for those receiving sham treatment (<i>P</i> = .01). <h3>Conclusions and Relevance</h3> In this trial of active-duty service members with PTSD symptoms (at a clinical threshold and subthreshold), 2 SGB treatments 2 weeks apart were effective in reducing CAPS-5 total symptom severity scores over 8 weeks. The mild-moderate baseline level of PTSD symptom severity and short follow-up time limit the generalizability of these findings, but the study suggests that SGB merits further trials as a PTSD treatment adjunct. <h3>Trial Registration</h3> ClinicalTrials.gov identifier:NCT03077919