Introducing Stellate Ganglion Block Treatments

The stellate ganglion is a bundle of nerves located near the last vertebrae of your neck. They are part of the sympathetic nervous system, or the “fight-or-flight” response. When a stressful situation activates our sympathetic nervous system and we go into fight-or-flight, cortisol (the stress hormone) floods the body. It is thought that experiencing trauma can cause the stellate ganglion to become hyperactive, triggering and re-triggering our fight-or-flight response long after the traumatic event occurred. The result can be chronically elevated levels of cortisol coursing through our bodies, which can cause or worsen symptoms of trauma, such as depression, anxiety, insomnia, hypervigilance, irritability, and more. For many, these symptoms can be so persistent that they disrupt quality of life.

A SGB injects local anesthesia near the stellate ganglion nerve cluster as a means of regulating—or “rebooting”—a hyperactive sympathetic nervous system response. It is thought that numbing these nerves for a short period of time interrupts a fight-or-flight response that is stuck in “on” mode and forces it “off,” enabling a reset of sorts. Once the sympathetic nervous system response has been re-regulated, PTSD symptoms can ease or stop. While SGB is not considered a cure for PTSD symptoms, it can bring meaningful relief that can sustain for months.

Before a treatment, we will ask you to fill out an intake form and let us know which medications you currently take. Unless directed otherwise, continue to take your medications as usual. The SGB treatment leaves some patients feeling temporarily light-headed; we recommend that you arrange for someone to drive you home after the treatment.

In addition to your health and safety, we care about your comfort during the treatment. After checking your vitals, we will invite you to lie back in a comfortable chair in one of our relaxing treatment rooms. We will insert a small intravenous catheter and administer IV fluids to keep you hydrated during the treatment. Next, with a small needle, we will numb the area in the neck where we are working; most patients describe this as a quick pinch. Listen to soothing music while our doctors use an ultrasound to locate your stellate ganglion on the side of your neck. Once located, we administer the local anesthetic; since your neck area will be numbed, you will likely only feel dulled pressure at the injection site. Throughout, you will be awake and alert, capable of talking with your doctor as she walks you through each step. The entire procedure will take about 15 minutes.

Side effects after SGB will happen, and all will resolve on their own within 24 hours. All patients experience the minor and temporary side effects referred to as Horner’s syndrome, which is an indication that the SGB is working as intended. Symptoms can include a drooping of the eyelid, redness of the eye, and a constricted pupil on the same side as the injection site. These symptoms pose no risk and will resolve naturally within hours to a day.

Other common and temporary side effects can include: nasal congestion, headache that can be relieved with Tylenol or ibuprofen, nausea, brain fog, eye sensitivity, dry eye, and temperature changes on the side the block is performed. You may also feel mild soreness in your neck. Most patients experience a hoarse voice as a result of anesthetic spreading to nerves in your voice box; your voice will return to normal once the anesthesia wears off, which can take about 8 to 10 hours. Lastly, since the anesthesia can temporarily numb your swallowing muscles, it can feel like something is stuck in the back of your throat or your throat is dry. While you wait for the anesthesia to wear off, eat and drink with care.

While the SGB takes about 15 minutes, the entire visit will last 45 minutes to an hour. It is not necessary to take the day off work, but we do encourage you to think of the SGB as a trip to the spa, designed to help you relax and experience a “reboot” that can dramatically reduce your stress.

Research shows that SGB patients experience relief from the physical symptoms of PTSD—such as elevated heart rate and blood pressure, the startle response, and so on—within days of treatment. Months after treatment, many patients reported sustained reduction in irritability and concentration problems. They also reported improvements in their sense of feeling emotionally numb or distant.

Many patients feel ongoing relief from one SGB treatment. One study indicates that two SGB treatments administered a week apart can optimize the benefit. We suggest that patients follow-up with us one week after their first SGB. Based on your response, you and your doctor can decide together if a second SGB is right for you.

SGB has been used for nearly a hundred years as a common treatment for chronic pain. A 1990 study reported that patients with PTSD who were being treated with SGB for chronic pain saw improvement in their PTSD symptoms. This led to several studies to understand SGB’s impact on mental health, as well as the most effective form of administration for trauma healing.

In the 2010s, a team of doctors completed a study with 166 military veterans suffering from PTSD. Three months after their SGB treatments, 70% of the veterans reported significant and ongoing symptom relief. Today, SGB is a routine treatment at VA hospitals that has brought PTSD relief to thousands of veterans. In fact, the VA’s success has led more doctors to offer or recommend SGB to patients suffering from persistent PTSD symptoms.

We are excited to be part of offering this safe and promising therapeutic to more people. At Soft Reboot Wellness, SGB is always administered by a board-certified anesthesiologist, with expert knowledge of the local anesthetics used in SGB. The treatment is completely safe and has helped tens of thousands of patients find meaningful relief from their PTSD symptoms and trauma-associated mood disorders.

Learn More: In 2019, 60 Minutes aired a segment on SGB for PTSD.

To date, nearly all of the research around SGB for mood disorders has focused on PTSD. If you have been diagnosed with PTSD, research shows SGB has a high likelihood of enabling meaningful and sustained symptom relief. We have also seen SGB bring relief to our patients with depression and generalized anxiety. SGB has been linked with: emotional and mental clarity; improved memory and concentration; reduced insomnia and enhanced sleep quality; decreased irritability; enhanced sexual function and intimacy; reduction in panic attacks; alleviation of social anxiety; improvement in fibromyalgia symptoms; improvement of POTS symptoms; reduction of long covid symptoms; and reduction or elimination of long-covid induced anosmia, parosmia, and dysgeusia. We invite you to speak to our health coach and discuss if SGB is right for you.

SGB can be safely used to augment the healing effects of ketamine. Full healing requires holistic changes, including lifestyle changes and incorporating a range of treatment options to address healing in both the mind and body. We consider SGB another option to round out a comprehensive treatment approach. Just as with ketamine, SGB works best when in cooperation with a therapist. We will ask you to log how you feel before and after SBG in Osmind so that you and your entire team can objectively assess your progress and offer additional treatment recommendations accordingly.

As always, our goal is to work in close partnership with you to find a comprehensive treatment plan that will most successfully reboot your mind and body and prepare them for healing. For many patients, SGB enables a meaningful break in trauma and mood disorder symptoms, creating an opening to incorporate other changes—such as diet, exercise, connecting with loved ones, engaging in things you enjoy—that are essential to your wellbeing and health.