How Stellate Ganglion Block Is Treating PTSD

Finding the right treatment for post-traumatic stress disorder (PTSD) sometimes feels daunting. However, the good news is that researchers are continually seeking new medications to increase the number of available treatment options. 

For example, one option is stellate ganglion block (SGB). This treatment became available for PTSD in the early 2010s. If you’re looking for a different treatment option, SGB injections could be worth considering in alleviating symptoms of PTSD. 

What is PTSD? 

Post-traumatic stress disorder (PTSD) is an anxiety condition caused by a traumatic experience. These events are typically frightening, shocking, dangerous, or extremely unpleasant. 

Trauma can have a significant impact on someone's mind and emotions. As a result, it can be challenging to cope with and may interfere with everyday life. 

Examples of traumatic events include:

• accidents and injuries

• disasters such as earthquakes or flooding

• bullying

• physical and/or sexual abuse

• terrorism

• violence

• war

• witnessing the death of someone else

• loss of a loved one

• separation from a loved one

PTSD is not easy to overcome. If you’re struggling with PTSD, it's essential to seek advice from a healthcare professional. 

What are the symptoms of PTSD? 

Several symptoms are associated with PTSD, and while many have been identified, it's unlikely that you’ll experience all of them. It would be worth making a list of the symptoms you’re experiencing. That way, your doctor can guide you toward a successful medication or therapy. 

Since several symptoms can be present, experts have divided them into different categories.

The categories for PTSD symptoms are: 

• re-experiencing or reliving symptoms

• avoidance symptoms

• arousal and reactivating symptoms

• cognition and mood-related symptoms

• somatic or physical symptoms 

Re-experiencing (reliving) symptoms

Re-experiencing symptoms is intrusive; with these symptoms, it feels like you’re reliving the traumatic event again. 

Re-experiencing symptoms include:

• flashbacks (moments when it feels like the event is happening in the present moment)

• nightmares

• frightening thoughts

• being triggered by certain people, places, or items that are reminiscent of the trauma

Avoidance symptoms 

Avoidance symptoms are related to things you avoid because they remind you of the trauma. 

Avoidance symptoms include:

• avoiding discussions of the trauma

• avoiding thoughts about the trauma

• avoiding places that remind you of the trauma

• avoiding people that remind you of the trauma

Arousal and reactivating symptoms 

Arousal and reactivating symptoms are related to how you respond when an aspect of everyday life reminds you of the trauma. 

Arousal and reactivating symptoms include:

• feeling tense and on edge

• feeling jittery

• feeling stressed and anxious

• having angry outbursts

• having mood swings

• being startled easily

• experiencing a loss of appetite or having difficulty eating

• having sleep problems such as difficulty falling asleep or staying asleep

• having difficulty concentrating or finding it hard to stay focused

Cognition and mood-related symptoms

Cognition and mood-related symptoms pertain to thoughts and emotions: in other words, how you feel. 

Cognition and mood-related symptoms include: 

• experiencing memory loss or having difficulty recalling aspects of the trauma

• blaming yourself for or feeling guilty about the trauma

• feeling detached from close friends and family

• feeling detached from the world or everyday life

• having negative thoughts about the world

• having negative thoughts about yourself

• having difficulty enjoying past interests or hobbies

Somatic (physical) symptoms 

Somatic symptoms refer to the effect PTSD has on your body when no other explanation as to what might be causing it can be identified. 

Somatic symptoms are:

• gastrointestinal issues such as nausea

• unexplained body pain and aches

• muscle tension

• decreased immune function

• endocrine imbalances

• elevated heart rate

• high blood pressure

PTSD treatment

If you need PTSD treatment, several options are available. These include medications such as antidepressants or talk therapies such as cognitive restructuring. 

Stellate ganglion block (SGB) injections are a more recent addition to the list of treatments. If you’ve found that previous treatments haven’t been effective, then SGB injections could be worth considering. 

What is stellate ganglion block treatment? 

SGB injections contain a local anesthetic or numbing agent such as lidocaine 1%. These injections target the stellate ganglion. 

The stellate ganglion is a cluster of nerves on either side of the neck near the voice box. These nerves are known to transmit pain signals. In addition, experts¹ think the stellate ganglion is linked to other conditions, such as vascular disease and PTSD. 

The local anesthetic in the SGB injection works by blocking these nerves in the stellate ganglion. As a result, nerve signaling in the stellate ganglion is temporarily interrupted or inhibited.  

Therefore, blocking nerves within the stellate ganglion can reduce the symptoms of certain conditions. For example, since these nerves are linked to head and neck pain, this pain is eased when a local anesthetic is injected into the stellate ganglion nerve cluster.

SGB has huge potential when it comes to treating disease. Conditions that SGB injections are known to help with include:

• complex regional pain located in the head, neck, and upper limbs

• orofacial pain

• atypical chest pain

• cluster headaches

• vascular headaches

• phantom limb

• peripheral vascular disease

• blocked arteries in the upper extremities

• chronic surgical pain

• Raynaud disease

• scleroderma

• Meniere syndrome

• intractable angina

• refractory cardiac arrhythmias

• post-traumatic stress disorder

• postherpetic neuralgia (pain that persists from shingles)

• hyperhidrosis (unexplained excessive sweating)

In terms of PTSD, the injection may reduce symptoms after it’s administered. 

How does SGB help PTSD? 

The exact underlying physiological mechanism that enables SGB to reduce PTSD symptoms is still being debated. However, since this medication is a local anesthetic, it works by temporarily blocking nerve signaling in the stellate ganglion. When these nerves are blocked, the symptoms associated with PTSD may be reduced. 

Some experts have suggested that SGB injections may reduce the symptoms of PTSD by reducing the blood concentration of adrenal hormones, which are associated with stress. Additionally, the sedative effects of this treatment may also have some effect on relieving PTSD. 

How is SGB administered?

If you require an SGB injection, it must be administered by a trained physician who specializes in delivering this treatment. A nurse will also assist by ensuring that your neck is in the correct position for the injection. Due to the risks associated with this treatment, you will have to visit a hospital or clinic for their administration.

Sometimes different techniques are used to ensure the injection is being delivered properly. For example, some physicians might use ultrasound or fluoroscopy, which requires a radiology technician. These techniques ensure that the injection is delivered to the right location in your neck. 

Is SGB a complete cure for PTSD?

SGB may not cure PTSD entirely. Case studies² have found that significant improvements were observed in 75% of the participants.

Currently, more comprehensive studies have been primarily conducted with active servicemen, with a randomized control study³ showing some improvement in PTSD symptoms over a short follow-up of 8 weeks. Further studies are needed to establish utility. 

How many SGB injections are required?

How you respond to treatment is another point to consider. For example, some people notice success after one injection, whereas others require more than one injection for better results. 

Currently, no standard recommendation has been determined as to how many injections are required. However, your doctor will most likely monitor your condition if you receive this therapy. From here, they may decide to administer more injections if they believe them to be necessary. 

What are the complications of SGB?

Like any medical procedure, complications may occur. 

These complications include:

• vascular puncture of an artery or vein

• neural (nerve) puncture

• pneumothorax (collapsed lung)

• thyroid injury

• tracheal and esophageal puncture

• Horner syndrome (disrupted nerve pathway in the face and eye)

• intravascular injection (large dose of local anesthetic into a blood vessel)

• neural spread of the local anesthetic

• infections (which can be treated with antibiotics) 

Who should avoid SGB treatment? 

If you have any of the following conditions, you may not be eligible for SGB treatment: 

• recent heart attack

• cardiac conduction block

• glaucoma

• certain nerve palsies

• emphysema

If you are currently taking anticoagulants (blood thinners), SGB may not be suitable for you either. 

Should you have any concerns, your doctor can discuss these with you before proceeding with the treatment. 

When to see a doctor

If you’re struggling to cope and feel that your PTSD symptoms are worsening, you should book an appointment with your doctor. 

You must also see your doctor if you’re considering SGB treatment. If your doctor thinks this treatment is a good fit, they can arrange a hospital referral so that you can discuss this option with a specialist. 

The lowdown

If you’re struggling with PTSD, the good news is that many treatments are available. Additionally, researchers are always looking into other potential therapies. Hence, SGB injections are now available for those who have not responded well to other PTSD treatments. You need to book an appointment with your doctor to decide whether SGB injections are right for you. 

Frequently asked questions

Can SGB help PTSD? 

In early studies, SGB injections have successfully alleviated or treated PTSD symptoms. However, this treatment may not work for everyone. 

Is SGB a hospital-only medication? 

SGB is a hospital-only medication because specialized hospital equipment is required to administer it. In addition, medical staff who are trained in administering the injection are also needed. 

Are SGB injections dangerous? 

Serious complications can occur. However, doctors typically use ultrasound techniques to safely administer the injection.