The Taproot Podcast - 💉Stellate Ganglion Block for Trauma and PTSD - Interview with Dr. James Lynch

Episode Date: October 24, 2022

Stellate Ganglion Block (SGB)—a medical procedure that effectively treats symptoms associated with posttraumatic stress disorder (PTSD)—is an injection of local anesthetic in the neck to temporarily block the cervical sympathetic chain which controls the body’s fight-or-flight response. 💉🚫🏃‍♀️🏃‍♂️ ​SGB has been safely used for over 80 years for many other reasons but was discovered ten years ago to provide relief of PTSD symptoms as well. 🕰️⚕️ Since that time, along with a handful of other physicians, I have pioneered the use of SGB for treating posttraumatic stress within the US Army. 🎖️🇺🇸 Due to its safety, success rate, and rapid onset of relief, SGB has gained wide acceptance in several locations at US military hospitals where it has been available. 🏥🌍 Check out more information about SGB and its applications here: https://www.drjameslynch.com/ 💻🔬 #trauma #ganglion #PTSD #treatment #therapy #cptsd #psychotherapy #neurology #Vasovagal #anxiety #nervoussystem #neuroscience Find more at: Taproot Therapy Collective Website: https://gettherapybirmingham.com/ Check out the youtube: https://youtube.com/@GetTherapyBirminghamPodcast Website: https://gettherapybirmingham.podbean.com/ Podcast Feed: https://feed.podbean.com/GetTherapyBirmingham/feed.xml Taproot Therapy Collective 2025 Shady Crest Drive | Hoover, Alabama 35216 Phone: [phone] Fax: [phone] Email: [e-mail] The resources, videos and podcasts on our site and social media are no substitute for mental health treatment. Please find a qualified mental health provider and contact emergency services in your area in the event of an emergency to a provider in your area. Our number and email are only for scheduling at Taproot Therapy Collective are not monitored consistently and not a reliable resource for emergency services.

Hi, it's Joel with the Taproot Therapy Collective podcast, and today I sat down with Dr. James Lynch and talked to him about the surgical intervention for trauma. You heard me right, surgery, not therapy, where the subcortical brain is regulated through injecting an aesthetic into the ganglia he's the doctor not me so i'll let him take that away but this is if you want to look it up a process called the stellate ganglion block that we're talking about, which can help patients of PTSD and trauma disorders learn to regulate emotion and control the symptoms of that disorder. I'm here with Dr. Lynch, and he's going to tell us about the stellate ganglion process,

which is like a surgical intervention for trauma and some other things, too. But we're kind of interested in its application for trauma here. And it probably would be funniest if I just explain how I think that it works as a non neurosurgeon. And then you can tell me you can correct where I'm wrong. But you're welcome to do that sure go ahead joel thanks for having me so yeah so the ganglia like you know the base of the brain you start to have the brain turning into the brain stem and connecting to the body and a lot of that is where trauma responses are stored so if you drill in between like the c6 and c7 vertebrae and inject anesthesia into those

roots of how the body has learned to physically hold emotion and trauma, then it relaxes them and makes them be reprogrammed. Is that, is that right? Yeah, I love that you gave me that to, to start off with. So this may be helpful and then stop me if I ramble, because I think in my experience, I've been doing stelaganglian block now for over 10 years. As an adjunct to trauma-focused therapy, it's been very helpful in patients with severe anxiety as well. Pardon me. But it's one of my favorite things to talk about because when you hear about what it is that we're doing and why, it just makes total sense.

And the fact that we hadn't figured this out much longer ago is a little bit puzzling. So the first thing is the stellate ganglion block. It's a very, very simple procedure. It's an ultrasound guided procedure that's done without a whole lot of fanfare. Frankly, it's been around for 100 years. So when people hear that they're usually fascinated that hang on a second this is not something new no not at all it's been around since the 1920s what's new is the application of using this procedure that's been around for quite

some time as a as a procedure used in pain medicine primarily the new part when i say new i mean really in the past 10 to 12 years it's been applied to treating essentially an overstimulated sympathetic nervous system. And that's exactly what it is. So the stellate ganglion block really refers to a nerve block using simple local anesthetic. And I'm only laughing because you did use the word drill. So I just want to reassure everyone. Honestly, there's no drilling involved. And the procedure takes literally a few minutes with a needle about the size of like a COVID shot or a flu shot.

And most people don't describe it as painful at all. They say it feels a little bit weird. And when it's over, most people just say that's it. That's all there is to it. Again, so and I think we're doing this on video, but the procedure was performed a hundred years ago by just touching next to the neck. There's a bone here at the C6 vertebrae, and then injecting along your finger, a local anesthetic. And that had been done like that for many, many years, way before the advent of ultrasound technology or fluoroscopy on thousands of people for pain conditions very successfully

with very few risks. So about 12 years ago or so, a few of us, myself and my partner, Dr. Sean Mulvaney, who are the two founders here at the Stelian Institute in Annapolis, Maryland, really started adopting this and researching it in the military. And that's really where both of our roots go. Although both of us are now since retired from the U.S. Army, but we take care of trauma survivors from all backgrounds. Initially, what we ran into was primarily combat-related trauma based on the population of people we served with. But we have since learned over time that that in no way

is the only type of trauma background that the stellate ganglion block can be helpful for. But just to give you that again, over 10 years ago when we discovered this, there was a report, kind of a random report in the literature of someone that was shot at a close range and had severe pain from gunshot wounds to the shoulder was treated with this procedure, um, for pain, the Stella ganglion block. Um, at that time, this was a young woman, um, who had severe PTSD developed from this assault as could be imagined, but was, um, completely unable to participate in therapy because of the amount of pain or distress, psychological pain that she was having that she couldn't even go in the door to the psychotherapist. Meanwhile, she was debilitated with her trauma, her traumatic injury. After the Stahl-Ganglian block series she received, her mood changed dramatically and she became much more willing to engage in psychotherapy as her anxiety

symptoms were dialed down so so that's really what started but but what the heck is the stellar ganglion block doing then if we're not drilling drilling holes in anything we're literally placing a numbing medicine called ropivacaine alongside a nerve in the neck but for it to make sense it has to you have to understand what the nerve is. So a lot of people who are in this area understand polyvagal theory and understand the vagus nerve, which controls the parasympathetic nervous system. And it lies also in the neck, both sides of the neck within the carotid sheath, just outside of the carotid sheath in the neck is a nerve called the cervical sympathetic chain or cervical sympathetic trunk. And this is the easiest way I'd describe it to

my patients or other people when I'm first describing it. So I hope this will make sense. But there are areas within the brain where the body stores threat responses. Many of your listeners know this and understand whether it's the amygdala, the prefrontal cortex, there are several connections within the brain where fear and threat centers and memories are stored. There's also several areas in the body that regulate or that feel the effects of the sympathetic nervous system. The obvious ones like the heart, the lungs, the muscles, the sweat glands, all these things are connected through a series of connections in the body, a series of connections in the brain, and all of them come together in a simple single nerve in the neck called the cervical sympathetic

trunk. That's the only thing that nerve does is it carries signals in two directions, body to brain, brain to body, and that's it. And that nerve essentially can become dysfunctional in some people. And by that, I mean- Is that from an environmental thing, like a trauma happens and then that stores some information about how to communicate with the body in a way that isn't helpful? Yeah, I think so. I think it's what's interesting is what, what it takes to, to get that nerve, to stop working properly could be anything. So for some people, it's a single traumatic event that has that traumatic experience can be enough to take what's essentially a circuit, right?

Because it's going to, so we're talking brain to body, body to brain. If there is something that conditions then a fear or a threat response in the brain, it then automatically triggers the body to respond a certain way. So you can imagine then if there's some insult, I'll just say, or some experience that causes that cycle to become dysfunctional, where it's all of a sudden now feeding back on each other, you can end up with a sympathetic nervous system that's inappropriately elevated or inappropriately stimulated.

That becomes the issue that we're targeting with this particular procedure. It's the thing that. Oh think that's where the cognitive therapy breaks down is where that response that's causing panic is coming from the body and we're trying to control it totally, mind over matter, but there's a negative feedback loop where my body is agitated. So my brain is stressed. Now my brain is stressed. It's making my body more agitated and leaving the body out of it doesn't treat the trauma a lot of the time. No, I think that's the point too. And something that's probably worth noting right now is I, I never have and never do consider the stella ganglion block, some standalone therapy. And you may run across some providers that'll say,

you know, I'll do this procedure and this will cure your anxiety or cure your PTSD or something like that. That's not that's not really the case. And some people might say that what I what I believe is what can happen is this dysfunctional connection between the brain and the body becomes a barrier to allowing you to just won't let you past it. And what you know, hundreds of my patients over the past 10 years have described is going to therapy and just not being able to break through. Or more importantly, I think, are the therapists I've worked with over the years who say, I just can't make the progress in therapy because the person is just, my client is just not calm enough in their body to make the

gains that I need to do. Or what would normally take three years in therapy following the stellar ganglion block can now take, you know, three to six months or something, because we have now taken essentially these two areas of the sympathetic nervous system and uncoupled them. You can relearn how to talk. Yeah. And then, so that's an interesting point because for many people, the, the effects of the stelagandum block are immediate, meaning within minutes, just in the exam room. The way the procedure is done is in an outpatient clinic. You don't have to go to a hospital or be in a fancy surgical suite done under fluoroscopy. In fact, it's done quite safe, more safely under bedside ultrasound.

And that's something that we do here at the Stellian Institute, you know, every day, just someone lying on the, on a patient exam table under ultrasound guidance, locating all the critical anatomy in the neck, and then really a simple ultrasound guided injection with a tiny little needle that most people feel very little at all. They say it feels a little bit weird. And then within recovery, within a few minutes in the recovery stage, people will notice things and many will actually report a physiologic release of something. And it's interesting because a lot of times it's hard to verbalize, but it's not uncommon at all for people to get quite emotional. Even people who haven't cried in many, many years may sometimes feel emotions well up or feel a release of some type of tension.

That's what I was going to ask is because we use, I'm not a practitioner of the physical therapy, but we work with ones that have an ROI sign so we can talk and they kind of feed back into each other but rolf massage or myofascial release where it's not a fun massage that's rubbing the sore place but you're kind of trying to rip the fascia and make the body unlearn how to hold an emotion those after their significant progress people just have a emotional flooding of older stuff that's not leaving brain spotting same thing i mean my experience was i've been in five different kinds of therapy, you know, they did different things, but then 30 minutes of looking at a pointer with brain spotting,

I felt this thing under my life in my body that I had been trying to turn off my whole life that I had not ever looked at that closely consciously. And then I could not turn it off. And there was two or three days of real raw emotional stuff. And then it was out, you know? so I was wondering when you hit that, does that start to what's the next couple of days look like? Does creativity come back online or is there more of an intuitive? I mean, do you notice patterns in what people report? Yeah, that's a great question. So there's two things, I guess, is we in terms of the science behind the symptoms that people have reported. These are things we've published in peer reviewedreviewed literature that can be found on the website.

The actual symptoms, you know, using DSM-5 criteria for things, those things are on there. The thing that's not, I think, is when you sit in the room with somebody after the procedure, and we just have some quiet music playing, and I sit in there, and I just allow people to relax, and I tell, you know, sometimes I'm not a therapist, so I don't, I don't pretend to be a therapist, but I'll just encourage people to let their, their brains go. If they've been trained in relaxation techniques, I help, you know, reinforce that that's a good time to do that, whether it's belly breathing or other things. And then the themes that people will, will report are actually quite interesting just that day. And the words that people will use to describe the feeling after a stellaganglion block are things like light or calm or more clear.

Many people describe they feel instant and immediate calm and their muscles relax and some type of a calm come over their entire body. So a physiologic thing as well as that mental thing. People also know a clarity of thinking. That one is still intrigues me, but people will use the different words to describe it as if the swirling thoughts in their heads have now calmed down, right? They can now just concentrate and think on one topic without balls bouncing around inside their head. And these are kind of the immediate, immediate things that people describe. What I think over the course of the next few days that many, many have reported back to me is the things that would normally upset you might still be there. And I think this is important

because it reinforces the point that this procedure is not a magic wand and it could be anything right it could be the slow driver in the left lane it could be you know your kid dropping a plate and a loud noise or something those things will probably still bother you but what the block may do is uncouple that immediate and autonomic or automatic response that you couldn't control before so that you would always just go zero to 60 if something happened and you had no control over that it was completely um reflexive for you what most people response is happening before thought even it's happening before conscious language-based prefrontal cortex thought so it's not something that you could sit and have insight

into to make it go away no and i think that think that's, you know, to your question, I think that's the thing that's interesting is people will then feel harmed and able to actually deflect that, which is interesting. And that people use different words to describe that. Like, I got a little bit of headspace. I got a little bit of leg room back. I got just enough time where I don't have to fly off the handle. And I realize this is something that would really upset me previously,

but I seem to be fine right now. And those could be other things like just being in a public place or, you know, the example comes up all the time of, you know, going to a restaurant and maybe not having to have your back to the wall now, or a loud noise, you may maybe don't respond the same way. So it's, i look at it as something that allows the um the automatic uncoupling of the body and the brain through the sympathetic nervous system i do think the people that have had deep-seated issues for long periods of time there's also an unlearning effect that happens and i think you said something earlier that made me made me think of that um some people do very very well automatically feeling much better

and to give that a number what we typically see is a 50% decrease in symptoms using whether it's a gad 7 or PCL 5 type score 50% drop in symptoms some people feel so good that they feel uncomfortable and I think that that's worth noting there some people oh my god I'm felt this good and so long it feels weird and then that that's worth noting there. Some people are just, Oh my God, I haven't felt this good in so long. It feels weird. And then that's where they work with their therapist to kind of get, get used to this new period or new phase of kind of unlearning some of the

safety response of if I'm feeling good, then that's bad because it's going to be taken away. As soon as I'm feeling good, I'm going to be punished. You know, that you get in some trauma when the body symptoms calm down, there's probably a more conscious panic response of, oh no, this is bad. I'm not allowed to feel like that. Yeah. There's, and I think that's a good point. And I think that's really one of the key things is for me, not a therapist who does the procedure. It's always

important to me that I, that I reinforce, Hey, we, we should try to tee this up so that you have an appointment with your therapist within the week or so afterwards. And I think that's critical. It allows people to just, you know, do this as a, as a team, not just, you know, some doctors somewhere off in Maryland is doing his own thing. So, uh, I really welcome that. And I find, um, that a critical component is if I'm working with new therapists that are not familiar with the block, I'm happy to take a phone call or an email or something just to work through like, okay, what's a good way to do this as a team? Yeah, the integrative approach is so important. I mean, that's one of the things that we work with. I mean, 90% of the calls that we get, we're never going to see those people's

patients, but we make sure that they're going to get what they need. We don't provide ketamine, we don't provide medication, we don't provide neur they need. We don't provide ketamine. We don't provide medication. We don't provide neurostim. We don't provide stellate ganglion blocking. We don't provide different kinds of massage. And one day maybe I'd like to, but, you know, with the massage and some other things, but we're able to figure out what you need.

Do you need one or two? You know, if you're going to do brain spotting, let's get you with a Rolf massage person. If ketamine or neurostim or stellate ganglion is better. I mean, one, the podcast is helpful because we can just send the interview with the provider to the person and they're hearing it i'm not just giving my impression badly of what i remember um but uh the issue we've run in with stelagangolin is just that their people do it here but they won't do it for trauma they want to do it for fibromyalgia and pain phantom pain

disorders but they won't screen the patient and see them for trauma they don't have a protocol for that or use it yeah yeah it's too bad it's so that's probably one of the most important things to say about the whole um the whole topic for anyone who's listening to this is saying hey this sounds like a pretty good deal why haven't't I heard of this before? There's a complicated answer to that question. But certainly one of the barriers is the fact that insurance does not pay for this procedure for behavioral health issues. And that's a significant barrier. Depending on where you look around the country, a lot of people charge somewhere around $3,000 for the procedure. At our clinic here in Annapolis, Maryland, which is right outside Baltimore and DC, we charge $1,200. And both myself and my partner,

Dr. Mulvaney, were the, probably fair to say the, if not the two most experienced, two of the most experienced in the procedure in the world, were the ones that have written published most of the original research on this over the past 10 years and when i retired from the army i came here specifically to join up with him so that we could form a center of excellence um having said all that you know we we try to make the procedure within reach and i i think a 1200 procedure is not within reach of many many people it isn't that's fair. That's a better price than we've seen anywhere, though. I mean, I was seeing $3,000 and $4,000 when I was looking at different places. Yeah, you'll see that amount of money. And I think other providers will do it under fluoroscopy in an OR suite. Some will use sedation, which we

do not do here, nor do we believe that that's necessary. In fact, believe that that has harm associated with it. So, so we don't. And like I said, we've done more than anybody else. And we, we spend a lot of time with our patients is the other thing. I think most places you go and you get a procedure, doc talks to you for a couple of minutes. And I like to spend, you know, close to an hour with my, my patients when they come. because I think if you're going to come and have some provider do a procedure like this, you want to get their experience. You want to hear from them. You want an opportunity to ask questions. You want to, you know, I don't think, at least that's what I think.

Spending an hour with a doctor is not common. I mean, your psychiatrist sees you for three minutes and writes a script when they hear anxiety three times. Yeah. So it's not their fault all the time. I mean, the industry realities in the industry that are not good forced changes and doctors and providers that weren't. It's not always their fault. Yeah. No, I think you're right, Joel.

And when you're limited to insurance and all the wickets that happen happen like that you're kind of shoved into a hole so in until insurance covers this um we'll continue to do what we're doing and then i guess the silver lining of that is we can take as much time as we'd like and provide the type of personalized care as we can without someone you know whipping us like like the rest of the medical community for right now. So I guess that's the good. Can people push the AMA and the APA to try and force insurance providers to cover it? To say that this is what's needed? I mean, there's this view that you have cognitive therapy and CBT just take over in the 80s and the 90s.

And a lot of it's reaction to psychoanalysis takes 20 years. We don't want to pay for that. want something faster but I mean you do have this attitude that will the body's a go-kart that carries the brain around if your body's sick go to the doctor if your brain is sick go to the therapist or the psychiatrist and that just isn't how it works I mean the neuroscience we have now is like it's in the interplay between those things and the emotional and the cognitive so I mean how fast do you see that changing? And what's the best way to kind of lobby the this unhealthy system to be

different? Yeah, I love I love it. I spent so in the in the 10 years or so that I've been doing the procedure, so I'm a full time clinician, you know, I'm seeing patients all day every day. We are still conducting research because we believe Dr. Mulvaney and I both believe that you're going to be relevant, you got got to keep studying what you're doing, keep making it better. So we're currently doing a randomized control trial with Ohio State University right now that we're paired with for a study that we're currently doing. We've got more in the chute.

And then really the advocacy piece has been a major piece for me. What earlier on when I was in the military, the advocacy was was designed for military active duty military and the veteran population. And it's been, you know, pushing a rock uphill for 10 years, frankly, it's just trying to change large organizations, what's available, what's covered. But I think we made some gains within that community. So there are VA hospitals who will offer the Stella Ganglion Block at no cost to veterans. There's just not that many of them. They're kind of sprinkled around the country. They have kind of mixed experience levels, and it comes up a lot. So we do take care of veterans and military who who don't have access to those um will come to see us as well but but to me the the now that i've been you know um focused a lot on on the

other eight million trauma survivors in the us is how do we how do we get that offered um you know across the board and i just think to answer your question how do do we best do it? I think what you're doing right now, you know, spreading the word, raising awareness with a, you know, a podcast is helpful. I think that patients that are, that may have influence, talking to the right people might help. I just am a little jaded at this point that it's just a glacial process. And although it doesn't make any sense to me that a, that a procedure that's been safely performed for 100 years that costs very little money and is very safe when performed by the right people and has an immediate impact, why that wouldn't be covered compared to all the other things that insurance pays for that doesn't make any sense.

It's just I'll just keep pushing the advocacy and awareness piece and hopefully the right people will catch attention to get the reimbursement piece caught up to us. I think it is more of a philosophical fear maybe than even a practical one that there's these, that if you start to rethink about medicine in this way, that the environment is a bigger variable, then how does one, how do you research it? Because there's too many variables and it's too big

and we want something where we can get it small and research it easy. But then also you're you're saying that medicine needs to be more integrative than it is and that i think that's a threat to a lot of um different parts of the current system yeah it is it's also just not what people are accustomed to on learning in my practice in north carolina i had, I had an office, I had right outside my office, two psychologists and a social worker. And we talked regularly. And, and that's not the case of where I am now in Maryland. So I've made efforts to try to

build those types of relationships and bridges with community providers around the state. But it's definitely not what people are accustomed to or what we're used to doing. So, but I don't care. We'll keep trying to do that. And I think people like it. I think that clinicians who want to take care of people, I think more and more are starting to see that, hey, this is okay. Teamwork's okay. I don't have to have all the answers myself. It's okay to reach across the aisle and ask someone from a different discipline to weigh in on stuff and and that's my hope at least is that that will um hit a tipping

point at some point and and people will become much more comfortable with reaching outside their discipline to do something that maybe they weren't trained of in their in their training but it's the kind of thing that they realize now there's plenty of evidence to support. Well, I want to be respectful of your time. I know you need to hop off. I just, I mean, I guess to close, we'll link to the website and everything so people can find you and your research. But I mean, if somebody is sitting there with trauma and they're trying to decide between ketamine, which is IV ketamine is expensive and not covered by insurance, Stelaganglion,

you know, NeuroStim is expensive and not covered by insurance. Brain spotting, if the provider knows a lot and has a bunch of the somatic training, then they're probably expensive. Maybe, I mean, that's the cheapest option, but it's still an investment. I mean, where do I start? What do I do if I'm looking

at these new exciting things? That's a good question. I think to answer this part, if you're interested in Stella Ganglion Block and you just have a lot more questions, for sure, look at our website, which I think you'll probably post up on a graphic, I guess. But it's thestellainstitute.com, all one word, dot com. On it, there's a whole slew of testimonials that I think are helpful for the personal story. But there's also full text journal articles of all the research that we publish on the evidence tab.

And then on the FAQ page, we try to answer literally all the frequently asked questions we get. And then there's videos in there, too. And they're all on YouTube as well. But the videos are to answer questions that are a little bit more, you know, sophisticated that you can't answer in a little three line sentence. So I would encourage people to do their homework because I think it matters. And I think if it's the right, it sounds like the right thing for you. If you're a therapist looking at your client saying, Hey, I think this person could really benefit from this, and then coming back to see me in therapy. Hopefully, a

lot of the answers to your questions are on that website. As far as how to get scheduled. At our place, we take either two things, some people will refer scheduled, at our place, we take either two things. Some people will refer themselves, which is fine in terms of access, preferably if there's a therapist who has a client to refer. I would love to do that, receive that from you. And we have a simple referral form that's on our website as well. If you scroll through the instructions, there's a hyperlink to a simple form. When in doubt, old school is fine with me, and I'm happy to take an email or a phone call with, hey, how do I make this work? But to try

to answer all those questions, we loaded it all up in kind of a contact us piece on our website to answer those things. As far as trying to decide which other modality to do, that's the million- dollar question. I have people come that have tried everything or they're in the process of trying everything. The only advice I'd have is if you're methodical about that, what can I try now to see if it makes a difference and then give it a little bit of time so you're not stacking things up together. And I have some people that will come and they say, well, I'm in the middle of a ketamine treatment. I'm doing this, I'm adding this. And I think that's okay. Like I'm happy to help you. But I think when it's,

when you get better, you're going to want to know which one it was that really helped. Although having said that, sometimes it just turns out to be a whole slew of things or a combination of things. So I wish i could give a better answer to that because i think that's the question and part of the the um the research that we're doing right now is to try to answer that question which is we feel fairly comfortable still getting any black works okay got it now what does it work best with how do we combine it with certain things so i think that's the next phase of what we're doing in research wise. Well, it was fascinating and I don't want to make you run late, but I really appreciate your time and hopefully and maybe if there's questions

or something we can do a part two, I don't know how much we'll, we'll see where it goes, but I really appreciate it. Thank you so much. Joel, appreciate your interest and thanks for what you do. Yeah. Thank you. All right. So that was our interview with Dr. James Lynch. If you want to check out more information on him, you can go to his website, which is drjameslynch.com. Again, that's drjameslynch.com, and thank you for listening.