PTSD-Related Pain Management With Dr. Eugene Lipov

 

Post-traumatic stress disorder, or PTSD, is a mental health condition triggered by terrifying events. It can cause severe anxiety, flashbacks, and even nightmares. Joining Timothy J. Hayes, Psy.D. in this episode is Dr. Eugene Lipov, a board-certified physician in Anesthesiology and Pain Management. Dr. Lipov pioneered the adaption of a well-known procedure called Stellate Ganglion Block (SGB) for treating trauma-related symptoms. Today, Timothy and Dr. Lipov dive into PTSD and PTSD-related pain management. With the possibility of an upcoming pandemic of PTSD following this Coronavirus situation, you might find this conversation informative and useful.

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PTSD-Related Pain Management With Dr. Eugene Lipov

Dr. Eugene Lipov is a board-certified physician in Anesthesiology and Pain Management. He has been practicing in the field of pain medicine since 1990. Dr. Lipov completed Northwestern Medical School in 1984, Anesthesia Residency at the University of Illinois in 1989 and Advanced Pain Training in 1990. Dr. Lipov pioneered the adaptation of a well-known procedure called Stellate Ganglion Block, SGB, for treating trauma-related symptoms. Dr. Lipov has treated over 200 veterans, including those through Healing Heroes as well as treated several hundred civilian patients with the diagnosis of post-traumatic stress disorder from all over the world. Dr. Lipov has treated military related post-traumatic stress disorder, military sexual trauma, PTSD due to first responder trauma and nonmilitary sexual trauma, pediatric sexual trauma and post-traumatic stress disorder from other traumatic events.

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Dr. Lipov, welcome. Thank you for joining us here. It’s a pleasure to see you again.

Thank you for having me. It’s been a while.

I usually like to start off asking people how did you get into this particular area of interest? What’s the journey that brought you into pain management?

Both of my parents are physicians. I was training to become a surgeon. My mother killed herself in the first three months of my internship. I had some issues following that. My father was depressed. It was a very hard time for me. I left surgery and I started in the anesthesia training. In the anesthesia training, there are a few different fields in the anesthesia. One of them is pain medicine. What I liked about that is getting rid of pain is meaningful. It takes a lot of skill sets that I was able to acquire. I also got a propeller blade injury. I understand something about nerve pain from my personal experience. As I was doing pain medicine, my brother and I came up with the idea of treating hot flashes, using one of them aesthetics techniques that we use called Stellate Ganglion Block.

We did that and it worked well, but the main problem has been people said, “We’re not going to accept that until we figure out why it works.” I started trying to figure out why it works. During that, I read about 3,000 articles about sympathetic block or stellate ganglion block and things like that. One of the articles was from Finland where a surgeon did teach clipping, which is basically putting an instrument in the chest and clipping some ganglion there for hand sweats. They found out it took away PTSD. I went back and I looked at the anatomy, it turns out this ganglion is connected to the neck ganglia. That’s why I proceeded to do an injection for PTSD.

There is an interest in PTSD because my father had PTSD from World War II and living with him was interesting. Also having seen my personal trauma was my mother’s death and the way she died was very traumatic for me. I was very interested for personal reasons. It allowed me having a stellate ganglion blocked done for me by my chairman. Mental health has a very big interest for me especially in therapeutics because of my mother. She was under the care of a psychiatrist when she died. If you look at dimensional therapies, a lot of times they’re not that effective or they’re slow to react. I prefer it to be effective and fast to react.

I had heard about the injury with the motorboat blade, but I hadn’t heard about your mother. I’m sorry to hear that. Many of us are motivated by our personal stories in this work. One of the things I like about what you’re doing, especially with veterans, you and I first met at a panel for veterans and PTSD is that many people are getting treated with psychotropic medications for post-traumatic stress disorder with little or no good results and often negative effects. It’s a long-term pattern. Can you speak a little about what you’ve learned about using psychotropics for post-traumatic stress and how it isn’t as good as what you’re proposing?

I can definitely talk to that. I’m not a psychiatrist, first of all. I’m an anesthesiologist. However, might’ve you all of the information available? There was an interesting article written in JAMA, Journal of the American Medical Association by Dr. Hug, who is a psychiatrist from Walter Reed from 2011. He said that therapeutic, which is psychotherapy and pharmaceuticals efficacy rate is about 40%. The reason he said that is because he believes that it’s a very low compliance. People don’t want to take medications because they’re not very effective and it takes a long time. Specifically, as far as medications, one of the most common drugs used by the VA right now is Resveratrol and Seroquel atypical antipsychotics major tranquilizers.

People don't want to take medications because they're not very effective and it takes a long time. Click To Tweet

There was a study done by Dr. Crystal from Yale. He basically did a large study on eleven VAs. They found that it was ineffective, but that in part that was those drugs is they can cause obesity and diabetes. One hundred thousand people per year use, their heart stops and they can die from that. A lot of times it seems to lead to anger issues. Many patients I’ve met who take those medication throw them down the toilet because they don’t want to take it. The other thing is there was studies showing that if you’re not consistent with atypical antipsychotics, the chance of suicide rate increases by a factor of three. I would say that whole class of compounds for PTSD is very problematic. The other drugs which are used for PTSD commonly is SSRIs. The efficacy is quite soft. The problem is a lot of times people have cocktails of benzodiazepines, barbiturates, highly addictive drugs. That’s very hard to get people off of that. It also can affect memory and other functions.

That’s one of the reasons that so many of us in the field are always looking for a feasible experiential or non-psychotropic way to help people with their trauma. I was introduced to the book, Healing Depression without Medication by Jodie Skillicorn. It’s a brand-new book. She talks about having read Robert Whitaker’s book on the Anatomy of an Epidemic and learning about how as a psychiatrist, she was trained to give all kinds of medications, which not only are not very effective, but often have negative side effects. She’s written this book about the various tools and techniques.

She’s using things that psychotherapists and psychologists are using to do experiential work to help people re-experience and heal. One of the things about that is it works with a certain number of people and it’s a lot of work. What you’re offering is a procedure that doesn’t put people on medication day after day, week after week. Many of the people that come to me have been told by their doctor they need to be on these medications for the rest of their lives. What you’re suggesting is a procedure that’s got a beginning and an end. It’s very quick. Can you tell us a bit about your procedure?

By the way, that book, Anatomy of an Epidemic is amazing. I read that book. That’s mind altering. The procedure we are talking about is I’m an anesthesiologist as I said. I’m not a psychiatrist. The whole concept behind this procedure is that people with PTSD have a sympathetic system, which is fight or flight, which is overactive. In pain medicine, the first time somebody calls stellate ganglion block, which is an injection in the neck was done in 1925 for hand sweating, burning or headaches. It’s been done for close to a century now. The idea is to manipulate the sympathetic or fight or flight system. The way the procedure works is we are blocking or rebuilding a sympathetic system to the pre-trauma state.

We do an injection in the neck that wouldn’t work and a lot of times it can work in 10, 15 minutes. The effect is very fast. It can last for months or years. What’s interesting is when people come in and they say, “I had this trauma and I have this happened to me,” I tell them, “I don’t need to know what happened to you. You don’t have to give me any information.” It’s very hard for people to recite all the trauma and everything they’re going through. They seem to like very much that this is relatively straight forward. All they need to do is be able to lie on the table. You place the needle in neck under the guidance. We put the medication in and 3 to 5 minutes they’re done.

How long before you know whether it’s had the desired effects?

A lot of times it’s immediate, meaning within twenty minutes. If it doesn’t give enough relief, then we take the patient back to the operating room and we do C6 injection, which is a sympathetic block higher up. Whether they do it like that, the success rate seems to improve from 70s to 80s or higher.

When you say you take them back, are you talking about within the same day, within the same period of time?

Within 20, 30 minutes because what it does is if you do it at C6 level and then fire up level, it seems to have a more of a reboot of the system.

Is there a need for re-application? What are the rates of people who might need it again? You said it works sometimes for hours or months?

The longest outlier we have now is several years ago, he got two injections. Some people need a few of them together. It depends on the biology of the person. It also depends on the amount of stress. For example, we treated a young lady who was molested by her uncle at six years old, we treated her for twelve. She was doing good for a year. Somebody tried to abduct her at a shopping mall and then we had to treat her after that. It depends on the amount of stress that happens later. Average number of procedures we do per person is about 2.5.

Over what period of time?

That’s an average number. The first one typically lasts a few months to a year and next one can last years.

Do you have some other examples of people who’ve benefited from it who weren’t responding to other medications or treatments?

We’ve treated various cohorts. We’ve treated a number of veterans. I’ll give you an example of this gentleman. He was a special-ops from Peoria, Illinois named Jason Brown. There’s a number of videos about him on YouTube. He was brought down twice when the helicopter was shot down. Following that, he was patrolling the streets in Iraq and a 10-year-old child was sent at him to take out the squad, which was laden with explosives. He shrugged the child, the pieces of the child hit him. He had severe PTSD. He came home and she tried to strangle his wife a few times in her sleep. We treated him several years ago. Again, he was doing great. He’s still married to the same woman and he is functional. He’s on no meds as far as I know.

I ran into someone who had been a Vietnam era vet and had a fairly typical pattern of whenever there was a helicopter going over or the 4th of July came, he was all but a basket case. He was not able to function normally when those kinds of noises would come at him. I’m not sure if you went to your clinic. I met him up here, out in the McHenry County, Illinois area.

That Raleigh Showens by any sense?

It might’ve been. I’m not all that comfortable talking about their names as you seem to be.

If you're not consistent with atypical antipsychotics, the chance of suicide rate increases by a factor of three. Click To Tweet

The reason I feel comfortable talking about him because he was on Fox News with me. He’s been out there on the media. That’s the only reason I can talk about names.

Let us know a little bit about that. I met him and he raved about the procedure.

That’s probably Raleigh. He and I met. He was unfortunately suicidal at the time. He had 40 years of psychotherapy, all psychotropics and nothing worked. We treated him in 2009. He’s still doing great. He had two stellates.

He had high praise for that process. I wasn’t sure that it was you who had done it with him. He’d been very active for veterans. I know that I had been doing as much work as I could to promote that I would use some of these noninvasive tactics. It’s not your procedure, but therapy procedures, mind, body energy work with veterans and do it for a very reduced fee or free. That’s how I ended up with him. The Veterans Administration up here in McHenry County was sending people to me and we had a connection through that. If it works with something that long lasting someone, who was in the Vietnam War many years ago, that’s very impressive.

As you mentioned, there are all kinds of people who’ve done practically every therapy they could come across and every medication that’s in the list with no good lasting results. Sometimes people get temporary results, but most of those psychotropic medications for that issue. If there is another traumatizing event, it resets the system. It’s good to have an option like what you present. Is there a way you can tell us how people find out about you? What’s the best way for people to reach out, learn more about your Stellate Ganglion Block?

If you go to www.StellaCenter.com, you can get all the information. If you’d like to have the procedure done, you can fill out the forms and things like that. I also have a non-for-profit organization. I belong to the ErasePTSDNow.org. If people feel obliged or they would like to donate something to us, no donation too small, no donation too big. We treat a lot of veterans at no cost, which we love doing and first responders as well.

Do you reach out to those first responders in a specific way? Are you doing marketing to them? How do people find out about you?

We work with some psychologists to work with them. We haven’t done a huge amount of marketing. We’re about to start to do so.

Where are you based? Where do you do this work?

 

In Downtown Chicago and Oakbrook.

You have two different places where people can receive this treatment?

Yes. They’re both ASCs, which is surgical centers.

Is there another category of person besides somebody who’s had an identifiable physical trauma or assault that might respond well to this technique? They’ve got symptoms related to hypervigilance or anxiety?

It seems to work on people with sympathetic over-reactivity, which is nightmares, over-reactivity stimuli or things like that. We’ve taken care of some patients who had reactive attachment disorder, not a huge number of those, but we’ve done some of them. They seemed to have worked with that. Military people, various cohorts we’ve taken care of people who were abused by clergy that has identified trauma. Not everybody has truly identified trauma, but my focus is on symptoms or sensitivity of sympathetic system. That’s what we’re trying to work on.

In one of our conversations, you mentioned is being able to scan to find out if a person was a good candidate for this. You also talk about how often when people say, “There’s nothing identifiable,” you have a hunch that we haven’t figured out that scan yet. There will be something going on within the person that are advancing scanning technology will reveal to us.

It’s more than that. People talk about the invisible wounds of the war or period invisible ones. My contention is that they’re invisible if you have their own scanner, that is at least two scanners, maybe three scanners which are available, which will tell you when somebody has PTSD, a high rate of certainty. The brain scans such as functional MRI, there’s a doctor that describe that in 1980. The amygdala, which is part of the brain that controls fear and anxiety, is overactive in PTSD patients. With the scanning technique from neurosciences, you can be about 90% sure who has PTSD and who does not. It’s not a matter of not existing. It does exist.

When people come to you, if they want to be evaluated for it, do you require those kinds of scans?

No, they’re not available clinically. This is a research tool right now. We use PCL.

PTSD is a biological phenomenon that's a diagnosable and treatable. Click To Tweet

Which is?

It’s a PTSD Checklist. It’s a standard way to assess people’s symptoms of PTSD and also how well they do after the procedures.

What’s the age range for people? You mentioned someone who was six. Did you treat that person when she was six?

No, she was molested at six. I tried not to treat children under twelve and usually there is no absolute top limit of age. It depends how healthy those people are. The oldest person I treated with PTSD was 88. I did a bunch of scans to make sure everything else was okay.

What’s the young end that you normally work with?

My usual cutoff age is twelve years old.

Do you get a lot of people that young with PTSD that are coming to you for treatment?

Not a lot, but I have a particular interest in those children because my son has some issues, but I certainly have done some very young people at that age. If you think about sexual molestation, especially in girls, it is very common, unfortunately or quite common at a very young age. How they’re behaving is a big problem. It’s very hard population to treat in general.

With this work, you’re getting good results as young as twelve but certainly older.

 

Yes, because again, the great thing here is compliance is very high. Keep in mind, I have done stellate ganglion blocks on 2, 3-year-olds when I did academic core for arm pain. Doing an injection in somebody that young is not that weird. It’s the indication is different.

What else do you want us to know about this fabulous option people have for resolving the effects of post-traumatic stress disorder? What is there about your work we haven’t even asked you about yet?

The future of trauma has a lot of potential. I’m proud to say that I am a Chief Medical Officer for organization called Stella Center. They’re a very high-quality outfit that plan between I and them is to develop having this available anyplace in the United States and internationally as we roll this out. The other product I’m hoping that people understand that PTSD is a biological phenomenon that’s diagnosable and treatable using biological methodology and rapidly. That’s the key, high compliance, high efficacy rate is what people are looking for.

If I remember correctly, you’re a board-certified anesthesiologist?

I’m board-certified in pain medicine, which is a separate board.

I want to point this out to people because a lot of times when a relatively new procedure or technique comes along, that’s one of the biggest questions I get from people. “Is it safe? Does this person know what they’re doing?” You certainly have been at this a long time and it’s got excellent results. I’ve been hearing about you in this work for at several years now.

That’s the one in front of US Congress from 2010, I have letter of support from Senator Obama from 2007. I’ve been working at this a long time.

It’s a pleasure to see you again. Thanks for talking with us and making this information available. StellaCenter.com is the website. Thank you so much for taking the time to be with us. It’s a pleasure to see you again.

Thanks for having me on.

Important Links:

• Dr. Eugene Lipov
• Healing Heroes
• Healing Depression without Medication
• Anatomy of an Epidemic
• www.StellaCenter.com
• ErasePTSDNow.org

About Dr. Eugene Lipov

Dr. Eugene Lipov is a board-certified physician in Anesthesiology and Pain Management. He has been practicing in the field of pain medicine since 1990. Dr. Lipov completed Northwestern Medical School in 1984, Anesthesia Residency at the University of Illinois in 1989, and Advanced Pain Training in 1990.

Dr. Lipov has treated over 200 veterans, including those through Healing Hero, as well as treated several hundred civilian patients with the diagnosis of PTSD from all over the world.

Dr. Lipov has treated military-related PTSD, Military Sexual Trauma (MST), PTSD due to first responder trauma exposure, non-military sexual trauma, pediatric sexual trauma, and PTSD from other traumatic events.

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