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Published on June 28th, 2012 | by RLn Staff

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PTSD Trials Start At Long Beach VA: The Quest For Answers to America’s $650 Billion Question


By Arthur R. Vinsel, Contributing Writer

Research is flourishing into brain chemistry’s role and new treatments for posttraumatic stress disorder (PTSD), the single costliest injury in wars spanning America’s history.

The $650 billion — the estimated cost for the next 20 years of PTSD disability benefits to men and women who served in Iraq and Afghanistan, and came back home scarred by emotional wound  — question is how to cope with it.

This is aside from the current annual treatment cost of $6,000 (counseling) to $30,000 (medication and other treatment) per man or woman, for thousands more Veterans Affairs patients who served in Iraq or Afghanistan. Cost estimates are up to $3.7 trillion to date, for two un-won wars, states Reuters News Service.

Modern weaponry virtually eliminates most close personal combat contact, but as the saying goes, “War is hell,” and it still takes a terrible toll.

Government records show 761 American troops were killed in action, from the 2002 invasion of Afghanistan until mid-2010, but during the same period, 817 committed suicide, mostly Army and Marine troops.

A recent document filed in the 9th Federal Court of Appeals states 18 veterans commit suicide every day in America and one in every four is enrolled in the VA medical system. Every month, 1,000 vets attempt suicide, VA records show.

The search for a successful treatment regimen continues on several fronts but there is no magic silver bullet to quell the costly torment that still hounds aging vets under treatment, 40 years after the Vietnam war, as well as the 1950-53 Korean Conflict.

Medication and psychotherapy remain standard, but fail in many cases. Psychotropic drugs perform differently in different patients and prolonged therapy disrupts employment and family life.

Many vets finally give up, but no treatment at all exacerbates problems such as alcohol and drug abuse, crime, violence and societal costs including law enforcement and social services, including welfare.

One experiment that utilizes a prosaic method is about to begin at the Long Beach Veterans Affairs Medical Center. It involves injecting an anesthetic — buprivicaine — into the right side of the neck, which is called the stellate ganglion block (SGB). It takes about 10 minutes.

The buprivicaine is injected into a star-shaped juncture of six nerves near the C6 spinal vertebra. The nerves are killed in one to three shots within one to three years.

Similar trials at other facilities show promise rather than perfection, although some patients with severe PTSD symptoms claim “miraculous” results with relief in 30 minutes.

Back in 2005, renowned Chicago anesthesiologist Dr. Eugene Lipov developed the SGB approach and retitled it The Chicago Block, to distinguish a safer method of injecting the anesthetic into the neck.

Previously, it was given in the C7 vertebra area closer to the heart and lungs, and without the benefit of X-rays to put the needle on target.

Buprivicaine has been around since 1925 when it was used as an epidural shot to ease labor pain during childbirth. That dosage wears off within a few hours.

“It’s amazing how many drugs long available turn out to be useful for something else later,” says Dr. Michael Hollifield, a psychiatrist in the Long Beach VA Medical Center’s Program for Traumatic Shock.

Dr. Michael Hollifield, a psychiatrist in the Long Beach VA Medical Center’s Program for Traumatic Shock. Photo by Arthur Vinsel

He and anesthesiologist Dr. Mike Alkire (the needleman) and supervising Dr. Christopher Reist are the three principal SGB researchers in Long Beach, but have other duties as well.

“We’re  about to start recruiting and interviewing men for our study,” says Hollifield, a tall Southerner who joined the team 15 months ago, just before the hospital Institutional Review Board began vetting its parameters. “All three of us have been interested in PTSD for quite awhile. We have about 3,500 in our department, accounting for 23,000 visits in the past year.”

They hope to begin in a  few weeks with 12 subjects, six from the Vietnam era and six fresher from the ordeals of war in the Persian Gulf action. Age will be a study factor, for PTSD never heals and goes away unaddressed, though symptoms may alter.

Prior to Long Beach, others have investigated SGB, as well. The U.S. Naval Medical Center in San Diego, Walter Reed Army Medical Center in Bethesda, Md. and the Pentagon have all tested or evaluated the nerve block method and were impressed.

However, the Department of Defense has turned down four proposals from 2007 to 2011 for funding a large study of SGB efficacy by simply responding that approved PTSD treatments are available now.

Specialists including a Harvard PTSD expert say the existing military and VA treatment regimens are not highly effective, but seem to do no harm.

Lipov plans to seek private sector grant monies for a study large enough to yield substantive results.

Alternative therapies that got a trial hearing from the military include providing veterans recreational and bonding time with dogs and horses, with unknown effectiveness.

The Pentagon also approved $3.75 million for a touring theater company to present plays by Sophocles and other tragedians at 50 U.S.  military sites on a theory they were used to help reintegrate warriors into society.

The Greek play therapy was also inconclusive in helping PTSD.

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