Stellate Ganglion Blocks, PTSD and Pain

What on earth is a stellate ganglion? Turns out we all have a stellate ganglion in our bodies. Yet the word, which sounds like the name of a deep-sea creature, is not understood by everyone. A ganglion is a “bundle of interconnected nerves”. The stellate ganglion is a star-shaped bunch of nerves found on either side of the voice box. It forms an element of “a bridge between the brain and the body called the cervical sympathetic chain”. The main function of this sympathetic chain is to control the “fight, fright or flight” response. The stellate ganglion “seems to control the activation of the amygdala”, an almond-shaped section at the base of the brain which is best known for its role in the human experience of fear.

This is an element of the body with a valuable function. Why then, would we wish to block the stellate ganglion? After a traumatic event, the regions of the brain responsible for our experience of fear can continue to fire, even though the danger is finished. The stellate ganglion is considered one of these regions. Within their lifetime, 12% of Australians will experience post-traumatic stress disorder, that set off declines in quality of life which can follow a traumatic event. The concept is that by sedating the stellate ganglion, we reduce nerve signals to the head, neck, and upper extremities. This way, those alarm bells continuing to ring may be silenced. Consider this a reset of the “fight or flight” device. Furthermore, those signals determine our experience of pain. Consequently, stellate ganglion blocks can treat a bunch of pain conditions, including complex regional pain syndrome, different cancer pains, and coccygodynia.

How do you block the stellate ganglion?

This is generally suggested for those who have not responded to conventional treatments. The block is a designed medical event with a rich history, being conducted for nearly a century. Let’s say you sign up for a stellate ganglion block. Your consent must be given. You will turn up to a clinic. You will be asked to be on your back. Your neck will be cleaned with antiseptic and numbed with medication. Then, with a fine needle, anaesthetic will be injected into the stellate ganglion through either side of the neck. With time, the technique to achieve this has been refined. These days, the trajectory of the needle is guided in real time by ultrasound visuals. Return to the block. That half of your face which matches where you were injected may experience temporary side effects. These include a droopy eye and warmth. These effects can remain for between four and six hours. Then, having completed the block, the experience of the patient is monitored to determine the effectiveness of the treatment. The block will have required only a couple of minutes. You might want a friend or member of your family to drive you home. Take it easy for a few days. Crucially, if you respond to the first injection, you will be recommended for repeat injections. There are usually two to four injections required.

How much evidence is there that stellate ganglion blocks (SGB) reduce the experience of PTSD?

There is confirmed talk of symptoms being reduced as rapidly as thirty minutes after the treatment, and this reduction can last for a decade. A dominant statistic is that in 3 of 4 times SGB will rapidly improve symptoms of PTSD. What about the future? Olmstod et al. (2020) surmised that “SGB merits further trials as a PTSD treatment.” Furthermore, the conclusion of Gunduz and Kenis-Coskun in “Ganglion blocks as a treatment of pain: current perspectives” (2017) was that SGB is “a safe and easy method that can be applied in intractable facial pain and headaches” of different origins. This is a fascinating treatment with relatively few complications and side effects, and whose future is bright.

Disclaimer

Anodyne is a specialised health service focused on patient centred and novel approaches for pain management and mental health treatments.

Any advice posted on our blog, website, or app is of a general nature and for informational purposes only. It is not intended to replace or substitute for any medical or other advice.

Anodyne makes no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical practitioner.

References

1. https://drseanmulvaney.com/stellate-ganglion-block-for-ptsd/: Opens in new window - Opens in new tab
2. https://radiopaedia.org/articles/sympathetic-chain-1: Opens in new window - Opens in new tab
3. 2007 National Survey of Mental Health and Wellbeing.
4. We must remember: “the specific mechanism of action by which SGB may mitigate PTSD symptoms remains incompletely understood”: https://www.ncbi.nlm.nih.gov/books/NBK442253/: Opens in new window - Opens in new tab
5. Tailbone pain.
6. https://www.ncbi.nlm.nih.gov/books/NBK442253/: Opens in new window - Opens in new tab
7. https://www.hopkinsmedicine.org/pain/blaustein_pain_center/pain_procedures/stellate_ganglion_blocks.html: Opens in new window - Opens in new tab
8. https://pubmed.ncbi.nlm.nih.gov/24760493/: Opens in new window - Opens in new tab
9. https://abovepain.com/treatments/stellate-ganglion-block/: Opens in new window - Opens in new tab
10. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2753810: Opens in new window - Opens in new tab
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734237/: Opens in new window - Opens in new tab

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