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Treatment that reduces PTSD should be allowed to be used by more veterans: lawmaker

Patriot-News - 6/27/2020

U.S. Rep. Scott Perry said he is on a crusade to pass legislation that provides millions of veterans access to a longstanding chronic pain treatment that has helped to improve the quality of life in military members diagnosed with Post Traumatic Stress Disorder.

“For many veterans with PTSD, they suffer from anxiety that they can’t shut off in their head long enough to have other treatments that are made available to them,” Perry said in a phone interview. “We haven’t been able to get the VA to get this treatment to be a primary source of treatment.”

The Treatment and Relief through Emerging and Accessible Therapy PTSD Act would direct the Veterans Affairs secretary to expand access to stellate ganglion block, or SGB, therapy to all veterans when diagnosed with PTSD by making it a covered treatment under federal law, according to Perry. He introduced the TREAT PTSD Act earlier this year but it hasn’t gained much traction since the onset of the coronavirus pandemic.

“If it passes, then your local VA would offer it as a primary care option,” Perry said. “Then a veteran wouldn’t have to try to fail a battery of other treatments. They could go right to SGB if they felt it was an appropriate treatment and work through the rest of the treatments, like therapy, in conjunction with it.”

Today is National PTSD Awareness Day. It’s celebrated annually on June 27 as a way to raise awareness of posttraumatic stress disorder, a mental-health problem that might develop after a person has been exposed to one or more traumatic events.

The urgency behind passing the bill is the link between PTSD and suicides, Perry said. Up to 20 veterans a day commit suicide.

Despite the treatment’s lengthy history of being used for mending chronic pain, it hasn’t been adopted as a use to help reduce PTSD symptoms. Among some in veteran circles, there is hesitation to support it without more proof that it won’t cause debilitating side effects. SGB has been around since the 1920s and is approved by the Food and Drug Administration.

Jodi Barone, of Lancaster, said the risk doesn’t seem to be worth the reward. Barone points to research published on the U.S. National Library of Medicine National Institutes of Health website.

According to the institute’s research, SGB can cause “life-threatening complications,” which are apnoea, unconsciousness, and seizures. The occasional “unusual complication” is “locked-in syndrome that causes patients to remain conscious despite their inability to move, breathe, or speak.”

Barone said, “My thoughts as a disabled veteran are that SGB has too many side effects that need to be addressed before pushing it out en masse to the Veteran community suffering from PTSD.”

Officials at the Lebanon VA Medical Center declined to provide a comment about SGB.

The shot, which is administered by anesthesiologists and anesthesia providers in the neck, is a mild anesthetic that targets the bundle of nerves that spark a “fight or flight” response in PTSD sufferers. The cost per injection runs about $1,000 to $2,000, and the procedure takes about two minutes.

The shot is used to treat chronic pain, uncontrolled sweating, hot flashes, and pain caused by shingles and angina. Through innovation, ultrasounds are now used every time to help locate the exact spot of where to inject the shot.

Veterans treated with SGB have seen PTSD symptoms such as hyperarousal, exaggerated startle response and anxiety reduced. A handful of physicians across the country throughout the past decade noticed when they shot a patient with SGB who had also experienced a traumatic event that the person’s PTSD symptoms also became more manageable.

“Until people are educated and understand what SGB has to offer all Americans, and people all around the world, we’re pushing a rock up a hill,” U.S. Army physician Colonel Jim Lynch said. “For that rock to get across the top of the hill, we need good rigorous studies that show, which requires a large burden of evidence, we have to adopt a new procedure.”

About 2 million veterans could stand to benefit from SGB and another 8 million civilians, Lynch said. On Thursday, he said he was spending his workday solely administering the treatment at Fort Bragg in North Carolina.

“I think there’s an opportunity to get a little bit of a foothold or at least a target if this were passed,” Lynch said. “We’ll have better research and then we can properly distribute it to millions of people living with PTSD. [It] doesn’t just happen in combat.”

There is a growing body of evidence that SGB works, Lynch said. The shot is not a standalone solution, he added.

“It’s been a team effort between several of us in close coordination with our psychology team,” he said. “That’s not the case everywhere. Some pain docs may look at this as a standalone thing, but that’s not how I view it at all. Add on psychotherapy and that creates a huge benefit that’s multiplicative and reaps better quality of life results.”

So why hasn’t it been utilized? Perry points to the VA for not taking action. As of 2018, there are only an estimated 11 VA facilities nationwide out of 143 that offer it.

Shauna Springer, chief psychologist of Stella Center and one of the nation’s leading experts on trauma, military transition and close relationships, said there is a very low rate of side effects, which do include pneumothorax or a collapsed lung and seizures. She pointed to a study conducted in Finland, where 45,000 people were involved; only 1.7 percent of the participants experienced side effects.

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Springer said she has worked closely with the pioneering physician who started to investigate the benefits of SGB on Veterans. She said when paired with intensive therapy, veterans have been able to have more productive lives.

“The treatment for anxiety works,” she said. “When the fight or flight factor is calm, then people can face what they would rather avoid. When you have a traumatic stressor, it changes your biology in fundamental ways. You can stay stuck in the fight or flight state. There will be requirements in order to have the procedure. Some people won’t meet the criteria because they have a cluster of symptoms that they can overcome, but they don’t have PTSD.”

People suffering from PTSD might not realize the kind of environment they are creating. When two people live together under these conditions, it’s not uncommon for the person with PTSD to affect the other person and influence their behavior negatively.

For someone who has PTSD, SGB buys time for someone who has difficulty managing their emotions, Springer said.

“During the global pandemic, in addition to everything we’re going now with SGB, I am anticipating a wave of sexual assault victims, and suicide attempts, not only in the military but in civilians,” she said. “We are going to have a greater mental health care need in this country. There are going to be changed to the models in terms of how we address trauma.”

The novel coronavirus caused a spike in anxiety for some veterans that Springer said she works with. Before that, she said she watched a handful of veterans receive SGB and manage the pending government orders to stay home much easier than some of their counterparts who struggled with their PSTD.

In addition to military members, Springer said she could see a need for SGB for frontline medical workers to police officers.

For veterans, though, they sign up for missions that improve the quality of life for others in both foreign and domestic locations, Perry said. They don’t necessarily say they want to go to war; that’s what politicians decide, he added.

Having worn the U.S. Army uniform, Perry said, “I’m not a victim of PTSD and I haven’t suffered from it.”

He said: “The legislation stands out there for consideration. We continue to see co-sponsors. With everything that’s going on, it is taking a back seat on the legislative schedule of our leadership. I don’t know if they are even considering it at all. I think that in a very hyper-partisan environment, there are very few things that most folks can find common ground. Veterans could benefit from this policy. We’re standing by ready to advocate and see it get passed, and see veterans avail themselves to a treatment that they have earned.”

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