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Stellate Ganglion Block (SGB)

During chronic stress or acute trauma, some people may continue to unconsciously activate the sympathetic system through a positive feedback mechanism despite no longer having the threat that started it all. This can negatively affect health and quality of life until the sympathetic and parasympathetic systems are brought back into balance.

Stellate Ganglion Block Q & A

What is a Stellate Ganglion?

The stellate ganglion is a collection of nerves (stellatum is a Latin word that means star-shaped and this ganglion is in the shape of star) in both sides of the neck that controls the sympathetic responses of the autonomic nervous system.

The autonomic nervous system doesn’t directly control movement and sensation like spinal nerve roots, but rather they control organ function like heart rate, digestion, breathing rate, pupil size, bowel and bladder function, sexual arousal, blood flow, reflexes, and much more. The autonomic nervous system has two main branches; the sympathetic is triggered by a reaction to fear and will stimulate a “fight or flight” response; the parasympathetic is triggered by relaxation and pleasure and controls “rest and digest” or “feed and breed” responses. In times of high stress, the body and mind can rely heavily on sympathetic control to enable you to fight or run away from a threat. During chronic stress or acute trauma, some people may continue to unconsciously activate the sympathetic system through a positive feedback mechanism despite no longer having the threat that started it all. This can negatively affect health and quality of life until the sympathetic and parasympathetic systems are brought back into balance. By blocking the sympathetic nervous system via the stellate ganglion, we are able to reduce the “fight or flight” response giving the parasympathetic nervous system time to allow the person to return to a state of rest and relaxation. This treatment may allow the person to break the physical, psychological and chemical patterns that have contributed to diseases like PTSD, depression, and pain.

Sympathetic overactivity can contribute to a variety of conditions and symptoms. Some of the conditions that the research has shown to provide therapeutic benefits include:

Painful conditions:
-Migraine headaches
-CRPS/RSD
-Phantom limb pain
-Post-herpetic neuralgia (post-shingles pain)
-Blood vessel spasms that are seen in angina and Raynaud’s disease

Non-painful conditions:
-PTSD
-Anxiety disorders

What is a Stellate Ganglion Block (SGB)?

The stellate ganglion block (SGB) is a procedure that has been used since the 1940s to treat a variety of medical conditions. The procedure involves an injection of a local anesthetic (numbing medicine) using ultrasound or fluoroscopic image guidance around the main nerve that controls the “fight or flight” response (the sympathetic nervous system), called the stellate ganglion.

SGB for PTSD/PTSI gained mainstream attention in 2019 after the Podcast The Joe Rogan Experience and the TV program “60 Minutes featured veterans sharing their positive experience with SGBs, but there have also been more than a dozen original peer-reviewed studies published since 2008 documenting SGB’s successful treatment of PTSD symptoms. New evidence shows the SGB as a promising novel tool to help those suffering from “long hauler” Covid-19 symptoms.

How Do Stellate Ganglion Blocks (SGB) Work?

The SGB is used to temporarily turn off the “fight or flight” sympathetic system using an anesthetic medication. As the numbing medicine wears off over the course of a few hours, the sympathetic system is then able to turn back on, or “reboot”, which can result in a new state of sympathetic tone that is more in harmony with the greater autonomic system. You can think of this as turning off your computer and restarting it if a program is acting glitchy. By temporarily numbing or “blocking” the traffic in the cervical sympathetic chain, it is believed that the parts of the brain that control the fight or flight response are allowed to reset, resulting in relief of symptoms.

How long does the procedure take?

Stellate ganglion block injections are safely performed on an outpatient basis at our private facility under real-time ultrasound guidance. The procedure itself typically takes less than 10 minutes to perform and is followed by a short recovery period before you are discharged. You will need a driver to take you home from this procedure.

How often should this procedure be done?

Usually, a series of SGBs are performed two to three weeks apart. A set of three injections is most common, although the timing and number of injections can vary depending on your condition and response to your first SGB. For example, you may experience considerable relief after the first or second injection. In this instance, you may decide that further injections may not be necessary.

What happens after the procedure?

Immediately following the procedure, you may temporarily experience what is called “Horner’s Syndrome”, in which you may have eyelid drooping, redness of the eye, and pupillary constriction. Don’t be alarmed – this is an indication of a successful SBG and occurs in nearly all cases. Other symptoms that may occur include temporary voice hoarseness due to anesthetizing the laryngeal nerve, and numbness and heaviness in the arm on the side in which the SGB was performed (typically on the right). Dr. Silva recommends that you rest for the remainder of the day and avoid strenuous exercise until the following day.

How soon will I experience results?

Some people experience immediate relief after the injection, while others experience a slower onset of relief within a few days or weeks. How long the relief lasts is different for each patient. Specifically in the treatment of PTSD, patients often feel a reduction in anxiety immediately following the procedure, with a significant reduction in panic attacks, irritability, intrusive thoughts, angry outbursts, and sleep disturbances in the days and weeks following the procedure. The SGB can also provide lasting pain relief with PTSD symptoms. 

How does Dr. Silva perform the SGB?

Dr. Silva performs all SGBs under real-time ultrasound guidance. His extensive specialized training in ultrasonography and image-guided injections make him uniquely qualified to administer this therapy to his patients. In the past, SGBs used to be performed without guidance just using palpation, under x-ray (fluoroscopic) guidance or with ultrasound guidance. While Dr. Silva uses x-ray guidance for other regenerative injection therapies, he chooses to use ultrasound for SGBs because fluoroscopy does not show the blood vessels and nerves, whereas ultrasound allows the needle to be guided to avoid these delicate structures in the neck while accurately treating the stellate ganglion. For this reason, ultrasound is considered the best method to deliver a stellate ganglion block.

Who is a candidate for SGB?

There are a variety of both painful and non-painful conditions that may benefit from this injection procedure. Stellate ganglion blocks (SGBs) are used in the treatment of pain in the head, face, neck, and upper extremities, and also in the treatment of PTSD and other anxiety disorders.

How does SGB help with PTSD and anxiety symptoms?

In those suffering from PTSD and some anxiety conditions, the person’s fight or flight nervous system has become stuck in an unproductive and chronic cycle. By blocking the stellate ganglion with a local anesthetic for several hours, this chronic response is turned off and thereby finally able to rest and reset. Several US military treatment facilities have used SGB to help thousands of service members suffering from symptoms associated with PTSD for more than 20 years.

Who is NOT a candidate for SGB?

SGB is NOT a treatment for Personality Disorders including Depression, Bipolar disorder, Schizophrenia or any variants of Schizophrenia. SGB is also not appropriate for the treatment of Seizure disorders or Traumatic Brain Injury (TBI), although PTSD symptoms can overlap with these disorders. Those who are on blood thinners that cannot safely discontinue these medications may also not be candidates. You will be screened in your evaluation with Dr. Silva for your candidacy for SGB.

Will my insurance cover SGBs?

In most cases, insurance will not cover the cost of an SGB. Our office will provide you with a superbill for insurance reimbursement purposes, but please note that you will most likely not receive reimbursement for these services.

 

 

 

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