Post-traumatic stress disorder (PTSD) robbed Cory Taylor, CD, of his peace of mind for many years, but a simple treatment he received in connection with a research case study was enough to help restore his quality of life.
Taylor, a former member of the Canadian Forces, is now part of a team from The Royal, The Ottawa Hospital, and the University of Ottawa who are exploring a procedure called Stellate Ganglion Block (SGB) to treat symptoms of PTSD. The procedure is available at VA facilities in the United States as an adjunctive treatment for PTSD, but the team would like to expand its use in Canada where it is currently approved for pain management and other sympathetically-mediated syndromes, but not PTSD.
The procedure – simple enough that it can be performed in nearly any pain clinic – can relieve some symptoms of PTSD in minutes. While not a cure, with additional injections, the effects could last for years.
PTSD is a mental health condition triggered by a traumatic event such as exposure to extreme stress, injury, or sexual trauma, and is associated with wide range of symptoms including insomnia, nightmares, panic attacks, difficulty breathing, flashbacks, intense feelings of horror, fear, anger, and a loss of interest in activities that were once enjoyable. Depression is common, which can make treatment more challenging.
According to a 2021 survey data released by Statistics Canada, five per cent of Canadians reported a diagnosis of PTSD, and eight per cent met the criteria for probable PTSD based on symptoms they experienced in the previous month.
The rate of PTSD among members of the military is even higher than in the general population.
Taylor joined the infantry reserve in 2003 and transferred to the Canadian Forces Military Police in 2006. He served a tour in Afghanistan and worked for the Canadian Forces National Investigation Service (CFNIS), the investigative arm of the military police. During his tour, he was involved in several convoy incidents, including an ambush. His PTSD symptoms were so severe he took early retirement for medical reasons.
He heard about SGB while listening to an interview with a US Navy SEAL. It inspired him to do some research, which he brought to Dr. Rebecca Gomez, a psychiatrist at The Royal’s Operational Stress Injury (OSI) Clinic in 2020.
Less than two weeks later, his phone rang. It was Gomez, calling about an appointment with Dr. Dan James, the director of the pain clinic at The Ottawa Hospital, who agreed to perform SGB on Taylor for a research case study.
“I wasn’t expecting it to happen that fast, but all the planets aligned,” recalls Taylor. “Dr. James had already heard of it being used (for PTSD) and he was familiar with the procedure. So it was ‘bing bang boom, we have a spot for you. Come on in.’ I couldn’t respond fast enough – 'Okay, great!'”
SGB is a simple and inexpensive procedure. A very fine needle – guided by an ultrasound – is used to inject a local anesthetic (similar to what a dentist would use) into a star-shaped bundle of nerves at the base of the neck connected to our “fight-flight-or-freeze” response.
For Taylor, the response to SGB was immediate.
“It was like the volume of the world got turned down,” says Taylor, who is married with two young teenagers. “It was indescribable – going from anxiety level nine to all of a sudden the world isn't trying to hurt you anymore. It's unbelievable.”
The changes continued in the weeks and months afterwards. There were big things, like being able to drive again (driving at night and during bad weather was particularly triggering), and small things too.
“It was just miraculous. This tiny little procedure that is absolutely so non-invasive to have such a dramatic incredible effect.”
“My wife actually remarked, 'I can see the part of you that has been missing, that was gone, that has been changed, is back,'” recalls Taylor.
To date, Taylor has received three rounds of SGB, all of which were over a year apart.
Researchers aren’t exactly sure why SGB relieves PTSD symptoms the way it does. The local anesthesia lasts five or six hours at most but its dampening effect on PTSD symptoms continues for much longer.
Nerve blocks for medical purposes aren’t exactly new. One of the best-known examples is the epidural. Used during childbirth, an epidural anesthetic temporarily numbs the spinal nerves and blocks pain signals to ease the pain of labor and delivery.
Gomez speculates SGB acts like a reset button by temporarily blocking nerves that travel from the stellate ganglion to parts of the brain that are more active in PTSD, ultimately decreasing the release of stress hormones like norepinephrine or adrenaline.
In November 2022, Gomez and her colleagues Dr. Jakov Shlik and Celia Geck from OSI Clinic, Dr. Clifford Cassidy from the University of Ottawa Institute for Mental Health Research (IMHR) at The Royal, and Cory Taylor, won an award with respect to their research case study on SGB. They presented their findings at the Canadian Institute for Military and Veteran Health Research Forum in Halifax.
The case study showed a significant decrease in PTSD symptoms for volunteer participants, such as sleep disturbances, intrusive thoughts, startle response, and flashbacks. Depressive scores dropped from the severe to moderate range, representing an overall significant decrease in symptoms for some participants.
“We didn't necessarily imagine that there would be a significant decrease in depressive symptoms,” explains Gomez. “It makes sense though, because in a lot of our patients their depression is dependent on their PTSD. They're depressed because PTSD is so debilitating.”
New treatments for mental health conditions don’t come along often and existing treatments don’t always work. Only 40-60 per cent of people with PTSD respond to medication, for example. It was one of the reasons Gomez was inspired to pursue this line of research.
Gomez hopes SGB will be approved for use as an effective adjunctive treatment for PTSD, in other words, a treatment given in addition to primary therapeutic interventions to maximize their effectiveness. For example, for Taylor, it opened the door a little wider to therapy by making it easier to get out of bed and deal with traffic and crowds. He has also reduced his need for prescription medications.
“It was just miraculous. This tiny little procedure that is absolutely so non-invasive to have such a dramatic incredible effect,” he says. “It feels incredibly overwhelming, just this sense of peace.”
Gomez says she gets goosebumps when she hears this kind of feedback, especially since the potential target for this treatment is broad, including refugees and survivors of violence and assault, for example.
The original case study included ten participants and an upcoming randomized controlled trial with The Ottawa Hospital will give this “miracle” shot to 54 former members of the military and RCMP who have PTSD. In the meantime, the team’s goal is to give as many people as possible access to this treatment through research studies. Although they are only recruiting veterans and former members of the RCMP at this time, the hope is that studies will soon expand to active members of the military and first responders.
“What gets me excited about this research is the response I've seen in the patients I'm treating,” says Gomez. “PTSD is such a difficult-to-treat condition, especially when you combine it with depression and substance use. Seeing the improvement is extremely inspiring and provides hope that I haven't seen with other treatments.”