American Society of Regional Anesthesia and Pain Medicine November 2017 - 58

The Authors Respond
We would like to thank Dr Lipov for his
interest in our work. The goal of the ASRA
News article was to review (1) the status
quo of research on the use of stellate
ganglion block (SGB) for the treatment of
posttraumatic stress disorder (PTSD), (2)
its implication on current clinical practice,
and (3) to encourage continued research
while taking reasonable steps to ensure
patient safety.
Without addressing each of Dr Lipov's
statements point by point, we will leave
it to the reader to study all sources of
information and come to reasonable
conclusions based on available evidence.
The ASRA News article can serve as
a guide to the literature even if your
assessment of the literature differs from ours.

Steven Hanling, MD, CDR, MC, USN
Navy Pain Medicine Specialty
Leader
Staff Pain Medicine Physician
and Anesthesiologist

We would, however, like to respond to a few specific items. Dr Lipov
commented on how the characteristics of the study population may
have affected the results of our study.
The potential impact of the study population and the methodology
has been consistently discussed by each of the authors at live
meetings, within our previously published article, and in the recent
ASRA News article. The conclusion of our study and the abstract
presented at the American Academy of Pain Medicine 2015 annual
meeting1 was as follows:
* "We cannot demonstrate any advantage of SGB over sham
injection for the treatment of PTSD.
* It is possible that SGB was underdosed, or that there are
subpopulations that benefit.
* SGB for PTSD is supported by evidence from case series, but
this RCT did not support those findings."
The letter also mentioned the previous positive trials. These positive
trials were noted in the ASRA News article and include our own
previous publication of a small case series showing success of
SGB for PTSD at Naval Medical Center San Diego noted in the letter
as reference 13. It was this very success that led us to want to
perform further research.

58

Ian Fowler, MD, CDR, MC, USN
Director Pain Medicine Center &
Fellowship Program
Staff Pain Medicine Physician
and Anesthesiologist

Robert Hackworth, MD
Staff Pain Medicine Physician
and Anesthesiologist

Naval Medical Center San Diego
San Diego, California

As for the comment concerning SGB-related complications, we agree
that catastrophic or severe complications are rare but do occur as
noted by Dr Wulf's article (reference 12 in the letter), which reported
on a survey of 76 departments in West Germany with a response
rate of 51%. Therefore, the results are subject to responder bias and
potential underreporting of catastrophic outcomes because of legal
concerns or market forces. Regardless of whether such bias exists,
our point on risk was meant to alert all clinicians who perform the
procedure to study the literature and available information for side
effects and harm that can result from this intervention. As mentioned
in our letter, although rare, catastrophic events can and do happen
and performing this intervention should not be taken lightly. Care and
caution should always be used with SGBs.
Dr Lipov also wrote, "To date, more than 2,500 military personnel
have been treated with SGB with good to very good success
(unpublished data)."
The authors are unable to comment on the safety and efficacy
results of unpublished data.
REFERENCES
1.

Medina-Torne S, Hanling S, Lesnik I, et al. US Navy's First Functional Restoration
Pain Program: improving readiness, restoring function, and relieving pain.
Paper presented at: 2015 American Academy of Pain Medicine Annual Meeting;
March 19-22, 2015; Washington, DC. Available at: http://www.painmed.
org/2015posters/abstract-172/. October 5, 2017.

American Society of Regional Anesthesia and Pain Medicine
2017
http://www.painmed.org/2015posters/abstract-172/ http://www.painmed.org/2015posters/abstract-172/
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine November 2017
