Stellate Ganglion Nerve Block
Stellate Ganglion nerve Block
A dual sympathetic reset stellate ganglion nerve block can be utilized to potentially provide relief from anxiety, PTSD symptoms, depression, and provide a reset to the fight or flight system.
Stellate Ganglion Nerve Block (SGB) can potentially have positive effects on:
PTSD
PANIC ATTACKS
ANXIETY
BRAIN FOG
ISOLATION
CHRONIC PAIN
DEPRESSION
IRRITABILITY
MEMORY LOSS
HYPERVIGILANCE
INSOMNIA
RAYNAUD’S DISEASE
WHAT IS A STELLATE GANGLION NERVE BLOCK?
Our nervous system contains to parts; parasympathetic and sympathetic. The sympathetic system is often referred to the fight or flight system and is activated in times of stress, survival, fear, and trauma. Chronic activation of this system can happen in PTSD and in people struggling with anxiety and panic. This leads to the symptoms of hypervigilance, insomnia, nightmares, overwhelm, depression, and physiologic symptoms (increased BP and heart rate).
A bundle of nerves is called a ganglion and the stellate ganglion is a cluster of sympathetic nerves in the neck that play a role in controlling certain bodily functions, like blood flow and sweating. By injecting a local anesthetic or medication into this area, the nerves are temporarily blocked. This can help reduce pain, calm overactive nerves, and improve circulation by “resetting” the system.
The procedure is FDA approved for pain and has been for years. More recently, research has supported the off-label use of this procedure for PTSD, anxiety, and depression treatment.
Peterson K, Bourne D, Anderson J, et al. Evidence Brief: Effectiveness of Stellate Ganglion Block for Treatment of Posttraumatic Stress Disorder (PTSD) [Internet]. Washington (DC): Department of Veterans Affairs (US); 2017 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442253/
Lipov EG, Jacobs R, Springer S, Candido KD, Knezevic NN. Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis. Pain Physician. 2022 Jan;25(1):77-85. PMID: 35051147. https://pubmed.ncbi.nlm.nih.gov/35051147/
How is the procedure performed?
The procedure is done in the Journease office while you are reclined in an anti gravity chair.
Dr. Coleman will use an ultrasound probe to look at the anatomy of your neck and mark the appropriate sites for injection.
An IV will be placed in the left arm prior to starting the procedure.
Then the skin on the neck will be cleaned and sterilized prior to starting the procedure.
A small amount of numbing medication (lidocaine) is put in the skin with a small needle and once numb another needle is directed to the C6 level of the stellate ganglion nerve using ultrasound. Subsequently the needle is then re-directed to the C4 level and a second injection is done. You will likely feel some pressure with the injections or a mild pinching, generally the procedure is not very painful.
You will be asked to rest in the office for about 20-30 minutes prior to leaving.
The procedure usually takes about 20-30 minutes but sometimes can be a little longer.
The stellate ganglion often is in the right side of the neck for most people, but sometimes can be on the left. If you do not experience benefits or symptom relief after a right sided block, it can be recommended to do the left side.
What can you expect after the procedure?
Immediately: Horner’s Syndrome - this occurs when there is damage or blockage of the sympathetic pathway. This pathway runs from the brain to the eye and controls many of the automatic functions like pupil dilation and eyelid position. The symptoms include: facial flushing and temperate change, drooping eyelid, and constricted pupil. Symptoms may vary from person to person. Depending on the course of the recurrent larygneal nerve, which can vary, you may or may not experience difficulty swallowing. These symptoms may last 4+ hours.
Hours/Days: Some people feel relief from pain or anxiety right away, while for others, it may take a few days for the benefits to kick in. If you experience benefits the effects can last for days, weeks, or even longer, depending on the person. Some people may also experience some flooding of emotions and we support all our patient’s with post procedure integration, therapists are available for referral if additional support is required.
Research supporting SGB benefits
Lipov EG, Jacobs R, Springer S, Candido KD, Knezevic NN. Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis. Pain Physician. 2022 Jan;25(1):77-85. PMID: 35051147. https://pubmed.ncbi.nlm.nih.gov/35051147/
Lynch JH, Muench P, Okiishi etal. Behavioral health clinicians endorse stellate ganglion block as a valuable intervention in the treatment of trauma-related disorders. Investig Med 2021;0:1-5. doi: 10. 1136/jim-2020-001693
Lynch J, Mulvaney S, Bryan C, Hernandez D. Stellate Ganglion Block Reduces Anxiety Symptoms by Half: A Case Series of 285 Patients. J. Pers. Med. 2023, 13(6), 958; https://doi.org/10.3390/jpm13060958
Mulvaney SW, Lynch JH, Hickey MJ, Rahman-Rawlins T, Schroeder M, Kane S, Lipov E.Mil Med. 2014 Oct;179(10):1133-40. doi: 10.7205/MILMED-D-14-00151.PMID: 25269132
“CSB seems to be an effective treatment for PTSD symptoms irrespective of gender, trauma type, PTSD-related drug use, suicide attempt, or age.”
“In a military population with multiple combat deployments, over 70% of the patients treated had a clinically significant improvement in their PCL score which persisted beyond 3 to 6 months postprocedure.”
“Stellate Ganglion Block Reduces Anxiety Symptoms by Half”
“Of surveyed behavioral health clinicians with personal experience incorporating SGB into their trauma-focused psychotherapy, 95% of respondents would recommend SGB to a colleague as a useful tool for the treatment of trauma- related disorders.”
Getting started: The process
pricing
Medical Evaluation with Dr. Coleman to ensure appropriateness of treatment and medical safety. Treatment recommendations provided at medical evaluation.
Schedule unilateral or bilateral SGB. Potentially schedule in conjunction with ketamine treatment.
Preparation session to medically and psychologically prepare for treatment. Any final questions can be addressed at this appointment.
Ultrasound guided SGB.
At least one post procedure integration session to support treatment effects.
This procedure is considered off-label for mental health indications and is only FDA approved for some chronic pain conditions. As a result, we do not accept insurance for this procedure and it is self pay. We accept cash or credit card. Payment is due at the time of service.
Medical Evaluation - required prior to all procedures, separate cost
Unilateral SGB - $1500: includes preparation and one integration session
Bilateral SBG - $2800: includes preparation and two integration sessions
Additional Integration Sessions - $150
Unilateral SGB with 2 Ketamine Sessions - $2600: includes preparation and two integration sessions
Bilateral SGB with 4 Ketamine Sessions - $4900: includes preparation and 4 integration sessions