Unanticipated elimination of bulimia symptoms following a cervical sympathetic block for treating Post-Traumatic Stress Disorder (PTSD) : A Case Report

Objective Report the efficacy of cervical sympathetic block (CSB) in treating PTSD as well as bulimia symptoms and discuss possible mechanisms of action to explain these findings. Background Successful treatment of PTSD with CSB has been reported previously in several publications. Bulimia has been associated with comorbid PTSD and is often comorbid with PTSD. Treatment of PTSD could be an effective approach to treat bulimia. Methods The patient received bilateral CSB at C6 and C4 levels on the right side followed 1 day later by the left side, as per clinic protocol. The patient’s PTSD symptoms were evaluated using the Post-Traumatic Stress Disorder Checklist (PCL-5). This checklist was administered one day before treatment and again 45 days later following treatment. Results CSB showed marked benefit for PTSD symptoms as demonstrated by significant reduction of PCL-5 scores following the bilateral CSB procedures. The patient spontaneously reported complete and persistent elimination of bulimia symptoms. Reduction of PTSD and bulimia symptoms were sustained at the 45-day follow-up. Conclusion CSB is a minimally invasive procedure with an excellent safety profile that may provide sustained relief of PTSD and bulimia symptoms. Considering the marked difficulties in treating bulimia, CSB may be a new ray of hope for the bulimia cohort. We believe CSB should be studied as a therapeutic approach for eating disorder patients with associated trauma in adequately powered studies.