ABSTRACT
Introduction
The lifetime prevalence for development of Posttraumatic Stress Disorder (PTSD) among military combat veterans has been estimated to be as high as 17%, or more than double the national average. The stellate ganglion block (SGB) has been proposed as a PTSD treatment modality that may potentially affect positive change in the attitude of a service member (SM) toward mental health treatment, lead to improved clinical outcomes, promote the likelihood of a return to a productive job performance, and decrease the economic burden of PTSD treatment on the Department of Defense.
Materials and Methods
A pilot program to determine the efficacy of the SGB was conducted in a single, closed-unit of active duty combat veterans with a statistically high prevalence of PTSD-related symptoms associated with combat deployments. A retrospective project-level program evaluation was completed to assess the effectiveness of the treatment in reducing symptoms, the level of SM acceptance of the procedure, and the SM perceived response to the SGB treatment. The project-level program evaluation methodology was based on the suggestions of the W.K. Kellogg Foundation Evaluation Handbook. The primary design and context of the evaluation was viewed from an outcome evaluation perspective and format, with focus on both individual and system-level outcomes. The outcome evaluation addressed: 1) the measured outcomes and critical findings of the procedure during the pilot, 2) feasibility of and recommendation for replication of the pilot, and 3) the quality improvement potential of the SGB as part of a clinical pathway for the care and treatment of PTSD in SMs.
Results
Program evaluation analysis demonstrated that the SGB exhibited success in both rate and level of response, reduced stigma relative to acceptance of the treatment, and SMs verbalized a high perceived value of the treatment. However, the effect of the procedure was shown to peak and plateau with a regression to baseline at roughly the 3-month timeframe, with a reciprocal decrease in perceived value.
Conclusion
The most significant benefit of the SGB appears to be its ability to act as a gateway to treatment and to facilitate active participation and compliance by the SM during its “window” of efficacy. Additional research, including RCTs are required to continue to evaluate its efficacy relative to symptom-specific effectiveness, effectiveness of sequential procedures, and effectiveness when combined with other nonpharmaceutical treatment modalities. Moreover, the application of an accepted medical procedure as a mental health (MH) therapy with marked reduction in stigma, encourages pursuit of additional such treatment methods that reduce stigma and promote active SM participation in PTSD management.
Energy extension service pilot program evaluation report: the first year. Volume III: supplementary reports