What if doctors could cure post-traumatic stress disorder with a single injection to the neck? One Chicago-area doctor claims he can, and has finally convinced someone in the Pentagon to give the idea a shot. And Danger Room has learned that some in the Navy believe the approach might actually work.
The freaky procedure is called stellate-ganglion block (SGB). It’s the brainchild of Chicago anesthesiologist Dr. Eugene Lipov. He’s touted the method for years, even winning then-Senator Barack Obama’s support in 2007, and he’s treated dozens of military personnel and veterans at his own clinic.
Until recently, Lipov was largely ignored by Pentagon brass and military doctors. All four of his applications for military research funding were denied. The most recent rejection came just last month.
But someone with the Pentagon’s funding review boards forgot to tell the Navy. One of its doctors is now several months into the first-ever military study on SGB — and she tells Danger Room exclusively that the method actually appears effective.
“I think of SGB as being similar to re-starting a computer, only we’re talking about circuitry of the nervous system and chemical pathways,” says Capt. Anita Hickey. Hickey is the director of Integrative Pain Medicine at the Naval Medical Center San Diego, where she’s studied a variety of new approaches to PTSD diagnosis and treatment among military personnel, including brain scans and acupuncture. “We’re seeing very positive results.”
The study is the latest evidence of the Pentagon’s increasing desperation to get a handle on PTSD — a frequently debilitating condition that affects an estimated 250,000 soldiers just from this decade’s wars, and thousands more from earlier conflicts. Doctors across the country are getting Pentagon dollars to study ideas as far-out as dog therapy and “digital dreaming” software. Capt. Hickey says that the Navy alone is currently funding 82 different studies on potential PTSD treatments. So far, nothing’s proven to be a magic bullet.
You can credit — or blame — the military’s recent embrace of holistics (acupuncture is now used in combat, and several military hospitals offer yoga) for Hickey’s SGB study. Last year, a senior Naval official heard Dr. Lipov present his idea to the House Veteran’s Affairs Committee. The official brought the idea up to top Navy docs, all of whom rejected it.
Then Capt. Hickey, a doctor herself, came along. An aficionado of alt-medicine and longtime advocate for combat acupuncture, Hickey thought the concept had potential. Hickey applied to the Navy for funding, and got $100,000 — even as other military doctors gave Lipov’s proposals the thumbs-down. She’s now midway through a long-term evaluation of SGB in 42 Naval personnel diagnosed with PTSD.
Capt. Hickey said she couldn’t divulge specific data from the study. But she did say that the process is double blind and placebo controlled. One group of patients receives a placebo, and neither doctor nor patient knows what was administered. The method is the gold-standard for rigorous medical research because it minimizes any subjective bias and helps distinguish real results from imagined ones.
“Of course, we’ve got more work ahead of us,” Capt. Hickey says. “But our team considers itself very open minded — if something works, it works. And with PTSD, we desperately need something to work.”
Lipov initially used SGB to treat hot flashes among post-menopausal women. When he dug up an old Finnish paper on adapting the procedure for PTSD, he in 2007 decided to give it a stab. Preliminary attempts worked incredibly well: SGB seemed to alleviate PTSD symptoms within five minutes, and one former Marine Corps Sergeant enthused that “I immediately felt more relaxed and calmed down. It’s been great.”
Unfortunately, Lipov wasn’t entirely sure how SGB targeted PTSD — hardly what Pentagon brass want to hear about an exciting new treatment prospect.
After subsequent research, however, Lipov in 2009 published a paper in Medical Hypothesis – a journal whose stated mission is to “publish radical, speculative and non-mainstream ideas” — describing how SGB seems to work. The injection of anesthetic, administered into a bundle of sympathetic nervous tissue in the neck, appears to turn off something called nerve growth factor. Nerve growth factor can surge during stressful experiences and promote the sprouting of nerves. That triggers chronic stress — what’s commonly known as the “fight or flight” response.
“If somebody’s circuitry is going haywire, then the anesthetic shuts it off, and reboots the system,” Dr. Hickey says.
Of course, you’d be right to think that rebooting a soldier’s nervous system sounds a little scary. And indeed, SGB isn’t without risks. The injection can trigger seizures, hit an artery or even puncture the lung, however rarely.
Those downsides might explain why the Pentagon hasn’t jumped all over SGB. Most recently, Lipov’s proposal for a $1.6 million study was rejected by the U.S. Army Medical Research and Materiel Command at Fort Detrick. Reviewers noted that the proposal was too ambitious and expensive for something that still lacked “a convincing neurobiological explanation.”
Sure, many in the military are open minded about new approaches to treating PTSD. But claiming to cure PTSD with one injection, when months of therapy and powerful prescriptions fail, hardly seems realistic. Not to mention that therapy isn’t accompanied by the risk of a punctured lung.
Still, there’s no question the military is running out of options. Giving more serious consideration to controversial ideas, such as SGB, ecstasy or marijuana, is likely only a matter of time. Lipov, for one, has no plans to stop pushing the Pentagon: He’s written a book on the procedure, and has a new study of his own, on eight veterans, being published in February’s edition of the journal Military Medicine.
Not to mention a new strategy for scoring federal research dollars.
“I’m done trying to get any money from the Pentagon, because they’ve got a broken, biased system for giving it out,” he tells Danger Room. “From now on, I’m just going to go straight to Congress and the Senate.”
http://www.wired.com/dangerroom/2011/12/navy-ptsd-neck-injections/
