

Military-backed efforts to find an effective treatment for post-traumatic stress are making sluggish progress. The Pentagon is funding all kinds of ideas – from yoga to telepsychology. Each has its limitations.

But one doctor is convinced he's found a viable way to treat the estimated 20 percent of troops now coming home with PTSD – if only the Pentagon would give it a shot.

Dr. Eugene Lipov, a Chicago-based anesthesiologist, pioneered the modern-day use of stellate-ganglion block, or SGB, in 2004 to eliminate hot flashes among post-menopausal women. SGB, which has been used to relieve migraines and chronic pain since the 1920s, involves a single injection into the sympathetic nerve tissue on the right side of a cervical vertebra.

After finding a Finnish paper on the use of SGB to treat anxiety, Lipov started trying it out on patients with post-traumatic stress.

"My first patient had been robbed at gunpoint," Lipov tells Danger Room. "He walked into my office with extreme anxiety, and walked out changed. That was three years ago, and he's still doing fine."

Lipov went on to try SGB in eight civilians and four veterans from Iraq and Afghanistan. His first patient, a vet who awoke to find himself strangling his wife, said the procedure's impact was "immediate." The effects took only seven minutes to kick in, but subsided nearly instantly after a fireworks display retriggered the condition. A second shot, in 2008, alleviated the PTSD again. "Since then, it's so far, so good," Lipov says.

It sounded promising, except Lipov and other SGB advocates didn't know precisely how the method actually worked – only that it did. That may have changed last February, when Lipov published a paper in Medical Hypothesis, describing what he thinks is the mechanism by which SGB targets PTSD. The injection appears to turn off nerve growth factor (NGF), which can surge during stressful experiences and promote the sprouting of nerves in the stellate ganglion. That triggers chronic stress, or what's known as the "fight or flight" response.

Lipov already has FDA clearance for use of SGB in post-traumatic-stress victims. And doctors at Walter Reed took note of the progress, and tried SGB on two veterans last year. "Although an admittedly small series of patients, our report points to a potentially effective and readily accessible approach for PTSD treatments," the study published in Pain Practice reads.

So does that mean Pentagon funding for Lipov's method? Not quite. He's applied twice for federal funds to sponsor further study ($4 million in 2007 and $1 million in 2009) but been denied both times.

Denied, despite one rather high-profile backer. In 2007, then-Senator Barack Obama wrote a letter to the Army as part of Lipov's funding application. "There is a growing body of evidence to suggest that PTSD is afflicting a growing number of our heroic service members," the letter reads. It "is important to consider any new approaches that may hold potential for helping our service members get the care they need."

Concerns over risks, especially that the injection can trigger seizures, hit a key artery or puncture the lung, are valid, Lipov admits. Still, they're rare: A 1992 study evaluating 45,000 SGB cases found adverse effects in 20 patients. And Lipov has come up with a distinct method, which he calls the "Chicago Block," that targets the C6 vertebra rather than the traditional C7. Because C6 is farther from important arteries and the lungs, it's less likely to be implicated in problems during an SGB procedure.

"Realistically, 1 in 100,000 people might have serious complications," he admits. "Say we treat 300,000 veterans – that's three people. Compare that to the military's suicide rate."

So far, the Pentagon isn't listening. Which makes sense: Yes, the military's been open-minded about investigating all kinds of alternative PTSD remedies. But there's a big difference between an hour of downward-facing-dogs and an injected chemical intervention that tries to 180 a patient's fragile hormonal stress responses.

But a dearth of Pentagon funds also means that an interesting idea goes under-researched. For now, Lipov is self-funding a limited clinical trial: a single-blind test of SGB injections on war veterans. So far, three patients have received the injection, and Lipov is looking to recruit 19 to 22 more. "Look, of course everyone would rather wait until 10,000 people have tried it," he says. "I'm trying to get there."

A single procedure costs around $800. Most PTSD patients have shown solid results with only one injection, but Lipov's first patient proved that there's a possibility of relapse. Questions also persist over how long the effects can endure, and what percentage of PTSD sufferers will respond to the method. And, of course, there's the undeniable fact that SGB injections are a Band-Aid treatment, rather than prevention or all-out cure. But according to Lipov, they're the best we can do.

"This has been around, it's been done, it is not going to grow you a new tail," he says. "It's out-of-the-box, I understand that. But, really, with the number of guys we're going to have coming home sick, I'm hard-pressed to see where there's a better option."

Photo: White House

Illustration: Eugene Lipov

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