Treating Anxiety / Headache and TMJ Disorders Associated with COVID 19 with Self-Administered Sphenopalatine Ganglion Blocks (SASPGB).
We are living in a period of very high stress and anxiety due to the Corona virus outbreak. Unfortunately, there is excellent research that chronic levels of stress and anxiety and associated sleep disruptions tend to decrease our immune responses.
Sphenopalatine Ganglion (SPG) Blocks are excellent for treating many types of pain including Chronic Headaches, Sinus Pain, Migraine and TMJ Disorders. SPG Blocks can also eliminate about 1/3 of Essential Hypertension that is secondary to Sympathetic Overload. They can also be extremely helpful with stressed induced insomnia, both sleep onset insomnia and sleep maintenance insomnia.
Many medical mental health specialists expect that we will see widespread Post Traumatic Stress Disorder (PTSD) problems secondary to this epidemic, both from the general public as especially from members of our healthcare community.
Chronic anxiety will also affect many when this crisis is over. This is a disease / condition of Sympathetic Overload (SO).
The use of Self-Administered Sphenopalatine Ganglion Blocks (SASPGB) are ideal for dealing with this type of stress, anxiety and PTSD disorders. The concept of Self-Care and active patient participation is well known to increase medical outcomes. Self-Administered Sphenopalatine Ganglion Blocks are a perfect adjunct for self care.
SASPGB are done with 2% lidocaine which has natural anti-inflammatory properties. There are other anesthetics that can be utilized but Lidocaine has multiple advantages especially safety and minimal toxicity.. Longer acting anesthetics are appealing if patients must go to the physician or Emergency Department but are not needed when utilizing self administration.
More importantly is that Self-Administered SPG Blocks (SASPGB) take effect almost immediately with virtually no negative side effects. Like all treatments different individuals will have unique responses. There are two available commercial products for doing SPG Blocks, the Sphenocath and the TX 360 and both are modified “squirt guns” for depositing anesthetic over the mucosa covering the medial wall of the pterygoid fossa behind which is the SP Ganglion. Swabs dipped in anesthetic are sometimes utilized but I personally utilize the Cotton Tipped Sterile Nasal Catheters the give continual capillary feed of anesthetic for greatly improved efficacy, convenience and cost effectiveness.
Some individuals respond almost instantly and seemingly magically to their first Trans-Nasal SPG Block (TNSPGB) while others respond best to a series of blocks.
Injection therapy is frequently utilized for severe patients who do not respond initially to a trans-nasal SPG Block. The Chronic Daily Headache and Status Migraine or continuous Migraine patient often respond fastest initially to an injection which can be done intra-orally through the Greater Palatine Foramen or extra-orally by the Supra-Zygomatic approach through the Pterygopalatine Fissure. This is the most direct approach to the Pterygopalatine fossa where the Sphenopalatine Ganglion resides on at the Maxillary Division of the Trigeminal Nerve.
The Sphenopalatine Ganglion Block has been called “The Miracle Block” and has over a hundred year history of safety and efficacy. Originally described by Greenfield Sluder MD in 1908 it faded in use as the pharmaceutical industry created quick cure drugs for almost every ailment. It may have been lost until the book “MIRACLES ON PARK AVENUE” was published in 1986. That book started the revival of the miracle block.
The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the cranium . The SPG also has Somatosensory nerves and carries sympathetic nerves from the Cervical Sympathetic Chain. The Stellate Ganglion (SG) is at the bottom of this chain. The Stellate Ganglion Block (SGB) has been called the Miracle Block as well and in some veterans one block to the Ganglion can cure PTSD. This is under study by the military. The Stellate Ganglion Block (SGB) will have a significant place in psychological treatments but is usually administered for Complex Regional Pain Syndromes (CRPS) also called Reflex Sympathetic Dystrophy(RSD) or Causalgia. The SPG Block will serve as an Indirect Stellate Ganglion Block (ISGB)
The Sympathetic response is known to cause icalmany medical issues related to chronic stress. The “Fight or Flight” reflex is a powerful reflex to insure safety or survival of an individual. If you run into Grizzly bear you get ready to run like crazy or fight for your life. While important for survival in Acute stress dangerous conditions the ongoing Sympathetic overload causes multiple diseases and dysfunction including headaches, migraines and anxiety.
The Parasympathetic Reflex is the “Feed and Breed” reflex or “Rest and Digest” reflex. The Parasympathetic reflex is primary in Romantic Love. It comes out when we play with puppies, kittens or babies and is a natural anti-anxiety response.
Patients suffering from Trigeminal Neuralgia (TN) often get the most lasting relief by utilizing a combination of injections initially followed by Self Administered SPG Blocks.
Nomenclature is important and I suggest that the following will be extremely helpful in dealing with Covid 19 Stress Disorders (CV19SD)
SPG= Sphenopalatine Ganglion
SPGB= Sphenopalatine Ganglion Block
SASGPB = Self-Administered Sphenopalatine Ganglion Block
SG = Stellate Ganglion
SGB = Stellate Ganglion Block
ISGB =Indirect Stellate Ganglion Block
SO = Sympathetic Overload
SR = Sympathetic Reflex
PR = Parasympathetic Reflex
SPGN = Sphenpalatine Ganglion Neuralgia also known as Sluder’s Neuralgia
PPG = Pterygopalatine Ganglion is the same as Sphenopalatine Ganglion named by location in Pterygopalatine Fossa
NG = Nasal Ganglion Same as Sphenopalatine Ganglion, Pterygopalatine Ganglion and Sluder’s Ganglion
SSPGB = Suprazygomatic Spehnopalatine Ganglion Block
IOSPGB = Intra-Oral Sphenopalatine Ganglion Block
GPFSPGB = Greater Palatine Foramen Sphenopalatine Ganglion Block
TNSPGB = Trans-Nasal Sphenopalatine Ganglion Block