Introduction

Post traumatic stress disorder (PTSD) management is often complex and requires a multidisciplinary approach. The first line management of PTSD revolves around trauma-focused therapy, often paired with pharmacologic management such as selective serotonin/norepinephrine reuptake inhibitors or alpha-1 antagonists for nightmares. If traditional modalities are ineffective, an adjunct treatment option includes the stellate ganglion block (SGB) (Schrader et al., 2021).

SGBs target the stellate ganglion at the base of the neck to address sympathetically mediated pain. Supporting evidence includes a randomized controlled trial that demonstrates significant improvement in PTSD symptoms compared to a sham injection (Olmsted et al., 2019). Under recent investigation is the utilization of SGBs for a wider array of psychiatric conditions. The existing evidence is primarily case reports/series in addition to a pilot randomized control study assessing their use in refractory depression (Kerzner et al., 2021; Sussman et al., 2023).

This case report examines a veteran with refractory PTSD, who noted improvement in both his PTSD and personality with serial left-sided SGBs. 

Case Report

A 50-year-old male veteran with a history of major depressive disorder and PTSD has been following with our VA based pain clinic for 8 years for PTSD management. He previously completed a psychoeducational course and was prescribed fluoxetine with some benefit. Despite this, he had ongoing nocturnal awakening and mood swings, including anger outbursts, anxiety and difficulty concentrating. He had been described as manipulative by his partner. Additionally, he had sharp shooting pain along the left side of his face.

Initially, he underwent a right-sided SGB with incomplete PTSD relief. Subsequently, a left-sided SGB was performed with significant improvement of PTSD symptoms including improved mood and sleep. He also noted improved left sided facial pain. Over the past eight years of treatment with SGBs approximately every 3 months, the patient reports that his personality has changed. He is no longer prone to outbursts of anger and feels more in control of his emotions. This has also been noted by his wife who reports he is less manipulative, generally less angry and more tolerable to be around. His friends and colleagues have reported the same change in his personality.  

Discussion

While SGBs are acknowledged as a treatment modality for refractory PTSD management, their utilization for a wider array of psychiatric conditions is still novel. The proposed mechanism for PTSD management is to decrease the hyper-arousability of the sympathetic nervous system, which we suspect may play a role in their mediating of this patient’s personality changes as well (Kerzner et al., 2021). His symptomatic improvement may also be due in part to reduction of his sympathetically mediated left facial pain managed with SGBs. This case contributes to the growing literature of potential novel uses of SGBs in the management of a wider array of conditions.