I’m Dr. Eugene Lipov, Chief Medical Officer at Stella, and I discovered a breakthrough treatment for PTSD. Ask Me Anything.

What are some key peer-reviewed RCT articles to show the efficacy and effectiveness of DSR?

EDIT: OP has replied below.

I couldn't find any.

Also it seems as if the SGB procedure itself (which the novel procedure is based on) has mediocre evidence at best for its effectiveness at treating PTSD.

https://www.ncbi.nlm.nih.gov/books/NBK442253/

First, SGB studies have generally been underpowered to adequately measure the most clinically important outcomes of remission, response, and serious adverse events. Second, although SGB has been recommended for use as an adjuvant for other therapies,53 evidence is insufficient to support recommendations about specifically when to initiate SGB in the order of recommended conventional pharmacotherapies and psychotherapies.

and

Findings from the first RCT of SGB for PTSD were inconclusive, neither confirming nor refuting findings of rapid and high rates of clinically relevant improvement and low risk of serious adverse events from unblinded, uncontrolled case series. It is appropriate to listen to criticism of the RCT, envision a better study of SGB for PTSD, and investigate whether SGB should be a higher priority than other innovative treatments for PTSD.

Nice, a modern day lobotomy

The Dual Sympathetic Reset (DSR), an advanced Stellate Ganglion Block (SGB) is an injection of local anesthetic into the stellate ganglion – a bundle of nerves in the neck – whereas a lobotomy treatment involves severing the brain's prefrontal cortex. These two procedures are vastly different procedures and serve very different purposes. SGB is not performed within the brain. It uses a local anesthetic that does not travel up into the brain.

Here are a few resources for you to look at:

Heliyon paper, 2023: Efficacy of combined subanesthetic ketamine infusion and cervical sympathetic blockade as a symptomatic treatment of PTSD/TBI in a special forces patient with a 1-year follow-up: A case report02098-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2405844023020984%3Fshowall%3Dtrue)

“Combined KI and CSB appear to have a profound and long lasting (over 1 year) impact on the symptoms of TBI and PTSD."

Pain Physician Journal paper, 2022: Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis

“Average decrease in PCL score for men and women was 28.59 and 29.2, respectively. Statistically significant improvements in PTSD symptoms were noted independent of the causative trauma type, gender, age greater than 20, previous suicide attempts, or use of prescription medications for PTSD. Among the 21 types of reported trauma, 19 types reached statistical significance.”

Stella Center whitepaper, 2021: From Post-Traumatic Stress Injury To Sustained Healing: A New Model For Care

“Results of this study showed clinically significant outcomes in over 80% of those treated within a single clinic visit. This is defined as a decrease in the PCL of at least 10 points, a standard of treatment success that is set by the National Center for PTSD.

Moreover, the average change in symptom severity scores was a drop of 28.59 points on the PCL for males, and 29.2 for females, respectively. Functionally, these decreases translate to taking someone with very high severity to a very low symptom severity level.”

JAMA Psychiatry paper, 2019: Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

“In this sham-controlled randomized clinical trial, 2 stellate ganglion block treatments 2 weeks apart were effective in reducing Clinician-Administered PTSD Scale for DSM-5 total symptom severity scores over 8 weeks. The adjusted mean symptom change was −12.6 points for the group receiving stellate ganglion blocks, compared with −6.1 points for those receiving sham treatment, a significant difference.”

I also wanted to share that we are currently conducting a clinical trial in partnership with NYU’s Langone Health, the results of which will outline the longer-lasting benefits of the treatment. That data should be peer-reviewed and published in the coming months. I will plan to update this thread with it when it’s live.

What have you found so far as to the long-term success of this treatment? After the nervous system 'reset', are there any needs for follow up treatments either medical or psychological to maintain the change?

Thank you!

The best results are achieved when patients get psychological help following the treatment like continued therapy. Meditation and yoga are also helpful to prolong the relief.

-Dr.Lipov

I feel it would have been quite important for OP to be transparent about the availability (or lack of) long term follow-up data. From a scan of what OP provided above, there is no clinical trial data reported beyond the 8-week or 30-day post-intervention period. It is not possible to validate any claims (certainly not for treatment more broadly) beyond what is simply described in individual case studies.

Hi xml3228 – I understand where you are coming from and wanted to provide a bit more insight into how we measure outcomes here. We send out core measures (PCL-5, GAD-7, PHQ-9, all of which are considered standard by the DSM) when evaluating whether a person is a good candidate for the DSR treatment – and then 30 days, 60 days, 90 days, 180 days and 365 days after treatment. Based on the thousands of procedures I’ve done, I have seen long-term benefits in a large percentage.

But I of course understand how important clinical data is to demonstrating the credibility of this approach. In addition to the peer-reviewed studies published in the other thread, we are currently conducting a clinical trial in partnership with NYU’s Langone Health, the results of which will outline the longer-lasting benefits of the treatment. That data should be peer-reviewed and published in the coming months, and I’d be happy to update this thread with it when it’s live.

Is the treatment a one-time procedure, or does it take multiple sessions? Also, does it prevent triggers in the future?

It may be a one time procedure or it may take a few treatments to give a prolonged effect, it is a case by case basis. Our success rate is about 80%, and it can help to lesson the effect of triggers in the future.

-Dr. Lipov

Could this be used for CPTSD, GAD, or conditions triggering the HPA axis?

Yes this can be used to help CPTSD and GAD. HPA axis can be affected by that but the benefit for SGB is for the sympathetic nerve and not the HPA axis.

​

-Dr. Lipov

MCAS?

I would need more information, what is MCAS?

It sounds like you are sedating the patient but in a more specific way. Are there downsides? What if an actual emergency or danger arises - do the patients have blunted responses?

Are you speaking about the procedure or long term treatment? We only use a quick twilight sedation for the patients during the treatment that wears off soon after the SGB is completed. The anesthetic used for the DSR SGB doesn't stay in the system long. DSR SGB does not compromise your survival instinct because it does not “turn off” your fight-or-flight response. When your fight-or-flight response is stuck in an overactive state, your body is constantly experiencing a high level of stress which can be due to an imaginary threat. For example, it can feel like you’re being chased by an imaginary bear. DSR SGB does not take your ability to run away from the bear. Instead, it removes the imaginary bear. Should a real bear appear, you will still instinctually run away from it.

-Dr. Lipov

My 4 year old nephew recently had a very scary encounter with a big dog in his neighborhood who ran up to him and chased him back home and then even came into the house. He wasn't hurt at all but now he's terrified of dogs and if anyone brings up the incident he just says "I don't want to talk about that." How can we prevent this from becoming a permanent traumatic experience for him?

I would suggest working with a pediatric phycologist to help desensitize him to dogs, they would have the best methods to assist with helping him get over the experience.

- Dr. Lipov

As far as I know, PTSD became known after Vietnam War, but also children with traumatic experience develop it. Is there any significant difference in symptoms between PTSD developed in adulthood and PTSD developed during childhood?

The symptoms are actually the same if experienced in adulthood or childhood.

-Dr.Lipov

Cases of PTSD that develop from early childhood to early adulthood before the brain has matured is commonly referred to as CPTSD (Complex Post Traumatic Disorder). But the DSM doesn't recognize it as a separate disorder and just clumps them together.

There are a few differences between the two and you can find many good videos about them on Youtube. Just search CPTSD symptoms/differences with PTSD.

I was diagnosed with PTSD but late came to realize my initial diagnosis was incomplete mainly because all the trauma I experienced was throughout my early childhood into my teenage years.

I’m sorry for your experience. As you likely know, PTSD (and CPTSD) occurs when prolonged or repeated trauma activates the brain’s “fight-or-flight” response and gets it stuck in overdrive, causing extreme physical and psychological symptoms including anxiety, insomnia, hypervigilance, headaches, and more.

The DSR treatment administers two doses of local anesthetic into a bundle of nerves on the side of the neck (the Stellate Ganglion), helping regulate the overactive sympathetic nervous and resetting the “flight-or-flight” response back to its original baseline state. This helps to alleviate or completely eliminate PTSD symptoms. According to my research, this procedure results in 81% of clients finding relief from their PTSD symptoms.

the term PTSD did but the precursor was called Shell Shock and that was coined after WW1.

At the beginning of World War II, the term "shell shock" was banned by the British Army, though the phrase "postconcussional syndrome" was used to describe similar traumatic responses (Jones, Fear and Wessely 2007, p. 1643)

Thanks. I didn't know about that.

no problem I wanted to be useful, rarely do I get to IAmAs early enough. And it seems this guy's research is eh at best (at least by the consensus of others on his lack of peer reviews). But I'm hoping I come back later and that will change.

Hi honorbound93, just wanted to address this – not sure if you caught the thread where I outlined relevant research, but I’ll paste it below. All of these papers are peer-reviewed (except the white paper of course, but I wanted to include that because of how comprehensive the document is). We are also in the process of conducting a formalized clinical study with NYU Langone Health on the long-term effects of the DSR procedure on PTSD, which will be peer-reviewed and published in the coming months.

Heliyon paper, 2023: Efficacy of combined subanesthetic ketamine infusion and cervical sympathetic blockade as a symptomatic treatment of PTSD/TBI in a special forces patient with a 1-year follow-up: A case report02098-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2405844023020984%3Fshowall%3Dtrue)

“Combined KI and CSB appear to have a profound and long lasting (over 1 year) impact on the symptoms of TBI and PTSD."

Pain Physician Journal paper, 2022: Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis

“Average decrease in PCL score for men and women was 28.59 and 29.2, respectively. Statistically significant improvements in PTSD symptoms were noted independent of the causative trauma type, gender, age greater than 20, previous suicide attempts, or use of prescription medications for PTSD. Among the 21 types of reported trauma, 19 types reached statistical significance.”

Stella Center whitepaper, 2021:From Post-Traumatic Stress Injury To Sustained Healing: A New Model For Care

“Results of this study showed clinically significant outcomes in over 80% of those treated within a single clinic visit. This is defined as a decrease in the PCL of at least 10 points, a standard of treatment success that is set by the National Center for PTSD. Moreover, the average change in symptom severity scores was a drop of 28.59 points on the PCL for males, and 29.2 for females, respectively. Functionally, these decreases translate to taking someone with very high severity to a very low symptom severity level.”

JAMA Psychiatry paper, 2019: Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms

“In this sham-controlled randomized clinical trial, 2 stellate ganglion block treatments 2 weeks apart were effective in reducing Clinician-Administered PTSD Scale for DSM-5 total symptom severity scores over 8 weeks. The adjusted mean symptom change was −12.6 points for the group receiving stellate ganglion blocks, compared with −6.1 points for those receiving sham treatment, a significant difference.”

I was diagnosed with C-PTSD last year at the age of 37. I also have ADHD. Since C-PTSD is not in the dsr yet, do you think such treatment would work for people like me, or only strong cases of PTSD ?

I have treated a number of cases of patients with CPTSD and they have been responsive to the treatment. Having ADHD doesn't seem to have an effect on the results of the treatment.

- Dr. Lipov

Is the treatment you found working for cPTSD? Is it available in other countries?

Yes the treatment has been shown to help patients who suffer with cPTSD. It is currently available in Israel and Australia.

-Dr. Lipov

how does this compare to existing treatments, I.e SSRI’s and CBT? Is this an adjunct or standalone treatment?

This treatment doesn't require you to take medications. We use CBT in conjunction with DSR SGB to assist in the patients healing journey. DSR works much quicker, it works within minutes compared to months.

-Dr. Lipov

What happens if patient is overdosed with this DSR injection?

If it happens it is very rare but we do have medication that can counteract the issue it's called intralipids. We do the injection under ultrasound guidance and if there are problems all of our physicians are equipped to handle an emergency situation.

- Dr. Lipov

Are you legit trying to say if someone develops LAST, it's cool because you have intralipid? The Hail Mary medication of toxicology?

Not at all – we take instances of LAST very seriously. We work extremely hard and take all the correct precautions to reduce these risks. I have been an anesthesiologist for close to 30 years, and train the staff I work with to follow protocols to ensure our patients are as safe as possible. I merely meant that no medical procedure is risk-free, and so if the worst case scenario does occur, we are prepared for it.

Hello Dr! Thank you for your time.

How does this compare to other treatments such as EMDR?

Is this a cure or are you treating symptoms?

Does the time duration since the event make any difference?

Is your method widely available? Is it available in other countries?

Hello Armbone,

DSR SGB compared to EMDR is much more rapid and the response seems to be significantly more intense since it is an invasive medical procedure. You would need to weigh the efficacy of the two since they are different treatments.

This is symptomatic treatment however if the sympathetic system can be reset to its pre trauma state it can help to reduce the symptoms for a prolonged amount of time. It's trauma so it's different than an infection that can be cured with an antibiotic. If someone experiences the trauma again there is a chance that PTSI can come back.

The time between if it's a new trauma vs an old trauma has not been studied yet. I have treated a patient who was a veteran from the Vietnam war, he received his treatment 50 years later and the results worked amazingly for him.

We shared my method widely throughout the US, it's also being done in Israel and Australia currently.

- Dr. Lipov

My phobia was diagnosed as a form of PTSD because it was based on childhood hospitalizations (that I don’t personally consider to be particularly traumatic), so it’s a rational fear rather than an irrational one.

Would this be effective for phobias resulting from trauma?

Potentially yes, this would help with symptoms you may deal with like anxiety when going into settings that could trigger you.

- Dr. Lipov

are benzodiazepines effective for PSTD?

No, benzodiazepines can be addictive and have shown signs of shrinking the brain.

-Dr. Lipov

What are possible side-effects of this treatment?

Serious side effects of the Dual Sympathetic Reset (DSR), an advanced Stellate Ganglion Block (SGB) are extremely rare because we identify the highest quality providers in the country and provide training in our best-practice protocols, which are based on the latest innovations in the field. We require that our doctors use image guidance for correct needle placement. After SGB, patients temporarily experience various symptoms on the right side of the body including a droopy, bloodshot eye, warmth in the face and arm, and congestion. Usually, symptoms last 6-8 hours, but in some cases, they last up to 24 hours. Nearly half of Stella patients experience hoarseness or trouble swallowing that resolves within 24 hours of the procedure.

- Dr. Lipov

Just curious but is this also a method "breaking" / "ending" an amygdala hijacking?

Given that a prolonged fight-or-flight response seems to harden the pathway to the amygdala versus the neocortex in order to speed up response time, will this treatment help?

It's awesome that someone is finally treating trauma as a brain injury and not a mind injury.

Yes, the Stellate Ganglion Block helps to de-active overactive amygdala leading to the improvement of PTSD symptoms.
- Dr. Lipov

This seems to be related to the concept of Memory reconsolidation, specifically chemical downplay of the amygdala during directed reconsolidation processes. Is this technique statistically more effective than the propranolol and/or sirolimus therapies that were attempted in the early 2010s?

Looks like they removed the body of the post so I dunno what to think about them anymore lol.

It was removed on accident by a mod and has been put back.

So in simple terms: two shots in the neck to reset PTSD. How long does the sedative remain active and the nerves suppressed? Lots of people have triggers from traume that send them back into a distressed state, would that mean you should first do emdr to work on triggers and the trauma. Or what would an optimal treatment roadmap look like?

It's a local anesthetic and it lasts in a persons system for about 8 hours, but the impact of the treatment can last months or years depends on the person. I think you can reduce the sympathetic and the uncontrolled response to help with triggers and then continue with therapy after. DSR SGB has been shown to have dramatic positive effects in many patients and can also help accelerate the positive impact of other therapies such as EFT, Talk Therapy, EMDR, CBT, DBT, etc.
- Dr. Lipov

Super fascinating stuff.

How does this interact with the more serious dissociative conditions, i.e., OSDD/DID, etc.? One of the primary issues with similar therapies (e.g. EMDR) in dissociative patients is that it's extremely likely to cause trauma flooding if not done extremely carefully.

We're super interested in this stuff, since we're always looking to improve the quality of our own care, as well as provide useful information to other OSDD/DID systems.

I have treated a number of people who have DID successfully, but you are correct that is has to be done deliberately and that is where post psychiatric care becomes important.

- Dr. Lipov

Have you looked into or seen any research that looks into the link between PTSD, stress hormones affects on gut flora, fecal transplants, and military members suffering from acid reflux at a high rate?

I have a hypothesis that gut flora and stress are linked and fecal transplants being a possible treatment for PTSD.

Thanks for the question, Nicke1Eye – very interesting hypothesis. I unfortunately haven’t done this research myself, but perhaps you’ve seen this paper? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794957/ It outlines the connection between PTSD and gut health (proinflammatory cytokines and low cortisol predispose individuals to develop posttraumatic stress disorder after a traumatic event). On the whole, we do know that there is an intimate connection between gut and mental health, so I’d be very curious to see more research on the topic.

How did this research and finding in particular change your personal beliefs on the connection between the concepts we call mind, body, and consciousness?

It reinforced my belief that the mind and the consciousness do not exist in isolation from the body, it has a very big impact of the body and how we think. Without a healthy brain there is not healthy consciousness.

-Dr. Lipov

What happens to someone who has to activate fight or flight but is under the effects of DSR?

Unlike the myth, DSR SGB does not compromise your survival instinct because it does not “turn off” your fight-or-flight response. When your fight-or-flight response is stuck in an overactive state, your body is constantly experiencing a high level of stress which can be due to an imaginary threat. For example, it can feel like you’re being chased by an imaginary bear. DSR SGB does not take your ability to run away from the bear. Instead, it removes the imaginary bear. Should a real bear appear, you will still instinctually run away from it.

- Dr. Lipov

If a person experiences new trauma after the procedure, what is the impact?

It depends on the severity of trauma, it may send someone back to having PTSI symptoms and would need to get the DSR SGB treatment again to help return them to the calm state. If it is relatively mild incident, it may have no impact on the person at all.

- Dr. Lipov

How do you know the appropriate level of PTSD to treat with drugs? Would you propose everyone, no matter how minor, turns to drugs rather than therapy or other non drug options?

The problem with psychiatric drugs as a whole efficacy is delayed, if non psychiatric treatment can be used I believe that would be preferable i.e. yoga, meditation, Talk therapy, CBT. But it would also depend on the person and their level of trauma that needed to be treated.

- Dr. Lipov

What are the signs of PTSD?

Spotting the signs and symptoms of PTSD can be difficult. Research suggests that only 2-11% of people experiencing trauma symptoms are actually diagnosed.

The 17 most common symptoms of PTSD include agitation, anxiety, problems with concentration, problems with memory, headaches, depression and crying spells, suicidal thoughts or attempts, mood swings, obsessive-compulsive tendencies, panic episodes, paranoia, shakiness, and substance abuse.

If you’re experiencing any of these symptoms and want to speak to someone about your symptoms or treatment options, call our Care Advocate team: (908) 293-7559

- Dr. Lipov

Is this the same thing as a nerve block?

It is a form of a nerve block, if all nerve blocks are cars then DSR is a Farai. The DSR builds upon and evolves SGB to relieve symptoms of emotional trauma. DSR involves two injections on one side of the neck – adding the C4 vertebrae on top of the SGB procedure’s C6 – that reset the brain’s fight-or-flight response to its baseline. The DSR protocol results in 80% of patients finding relief from their PTSD symptoms.

- Dr. Lipov

Is this treatment applicable/feasible for people that suffer from significant phobias?

Yes, it is able to help with symptoms related to phobias.

- Dr. Lipov

For those with cPTSD, does the procedure effect the patients personality in any way?

Yes, it helps to make them less anxious, they can sleep better and it can make them much more relaxed.

- Dr. Lipov

1: Any time frame on when this could be available in Europe?

2: does this also affect one's personality in general?

3: I have anxiety of public speaking. Could this be tested with that too?

I don't know about when it would be getting to Europe but as for affecting someone's personality it normally makes people less anxious and more relaxed and calm.

- Dr. Lipov

Can you elaborate on what you mean when you say PTSD is a biological phenomenon? What else could it be?

Despite extensive research into PTSD, many people don’t realize that it is a biological brain injury. The brain’s fight-or-flight response gets stuck in overdrive, causing debilitating physical and psychological symptoms. Research shows that 60% of men and 50% of women experience trauma at least once in their lives, and yet only 2-11% of people experiencing trauma symptoms are actually diagnosed. PTSD is a critical mental health issue that often goes undetected – the more conversations about it like this that we have, the better.

(Citation: https://www.ptsd.va.gov/understand/common/common\_adults.asp, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310322/)

Why removed?

The post was removed on accident by a moderator it has since been restored.

[deleted]

Stella is an emerging leader for the treatment and research of post-traumatic stress and related mental health conditions. If you want to speak to someone about your symptoms or treatment options, call our Care Advocate team: (908) 293-7559 you can also find more information on www.stellacenter.com

- Dr. Lipov

What are your thoughts on ketamine therapy?

Ketamine can be effective, in fact we often combine Ketamine therapy and DSR SGB for an improved effect.

- Dr. Lipov

Hi there,

There's a special PTSD situation that I'm curious if this could handle.

Most PTSD, or at least the popular perception of it, is in response to a traumatic event that the person is now far less likely to encounter. Such as the PTSD's origin being from a military deployment and being shelled, and it remaining after returning to civilian life, where being shelled isn't really a danger anymore.

However, that is not always the case. Sometimes the risk level of the traumatic event's recurrence has NOT decreased.

Imagine a professor who refused to sleep with a student in exchange for increasing a student's grade. She then creates a false accusation against the professor. He manages to beat the false accusation, but not after having gone through a difficult process, developing PTSD in the process. Here's the thing though, unlike the soldier example above, the risk is equally as likely now.

So to my question:

Would the treatment be effective in the professor's case, as well as the soldier's case?

The DSR procedure can help relieve symptoms for both experiences of PTSD that you mentioned above. The impact of this treatment can last months or years, depending on the person, but the difference between new trauma vs. old trauma has not been studied yet. Anecdotally, I treated a patient who was a veteran from the Vietnam War. He received his treatment 50 years later and the results worked amazingly for him; I also regularly treat folks who experience ongoing PTSD, and the procedure has also been effective for them.

It's always been my - very limited - understanding that people suffering from PTSD are "haunted" (for lack of a better word) by the memories of the event that traumatized them, and that them being unable to forget these memories and having to relive them over and over, and the accompanying stress this causes, cause the symptoms that you listed that we associate with PTSD.

Am I in the right ballpark, and if so, how does your treatment deal with people's memories of their traumatic events?

There are two type of memory, one lives in hippocampus and the emotional memory that resides in the amygdala. Those that reside in the amygdala that cause an emotional response can be reset with DSR SGB. To help with getting through the other memories I recommend seeing a psychologist to continue working through the trauma.

- Dr. Lipov

Does this help with an acute PTSD episode or is it more intended for symptoms over a longer span of time?

We are in the process of publishing peer reviewed data on the lasting effects of the procedure, but generally speaking, I have seen it help with both acute and chronic / long-term PTSD symptoms. It truly does depend on the person, but DSR has the potential to last multiple years.

We send patients who have undergone treatment core PTSD and mental health measures (PCL-5, GAD-7, PHQ-9) 30 days, 60 days, 90 days, 180 days and 365 days after treatment, and have many patients whose relief continues well into these longer time spans.

I think it's interesting that your procedure takes what I as a lay person consider a mental trauma and you've found that it's in fact linked to a physical "symptom" (for lack of a better word).

What led you to discover that PTSD had a physical component that could be treated? Do you think other mental ailments have physical remedies as well?

Thanks for the work you're doing!

During my work with hot flashes I was trying to determine why stellate ganglion block, the predecessor of of DSR, was working for hot flashes. During an investigation I came across a paper from Finland where they found clipping took away hand sweats as well as PTSD symptoms. After further investigation I found the T2 ganglion becomes the stellate ganglion in the neck and the stellate ganglion connects to the brain. Also yes, the first use of SGB was actually used for depression, so I do believe their are other mental ailments that we can find physical remedies to in the future.
- Dr. Lipov

We’re organising a health conference in Europe, how can I get in touch to invite you as a speaker?

That would be an honor! You can email [email protected]. I appreciate it.

So where can I sign up? This sounds amazing

You can speak with one of our Care Advocates to kickstart the conversation around finding relief at 412-385-6880