Stellate Ganglion Block: A Versatile Treatment for Diverse Conditions - A Brief overview of Current Evidence

Stellate ganglion block (SGB) is a minimally invasive procedure involving the injection of a local anesthetic near the stellate ganglion, a network of sympathetic nerves located in the neck. By modulating sympathetic nervous system activity, SGB has demonstrated promise in addressing a wide range of conditions characterized by sympathetic overactivity or related dysfunction. This article reviews the peer-reviewed evidence supporting the use of SGB for specific medical and psychological conditions.

Post-Traumatic Stress Disorder (PTSD)

SGB has been extensively studied for its potential in treating PTSD. A randomized clinical trial demonstrated that SGB administered twice over two weeks significantly reduced PTSD symptoms over eight weeks compared to a sham procedure (Hanling et al., 2016). Similarly, observational studies and case series report marked reductions in hypervigilance, emotional dysregulation, and other PTSD symptoms following SGB (Mulvaney et al., 2014).

Anxiety

Beyond PTSD, SGB has shown efficacy in reducing generalized anxiety. A systematic review noted that patients with anxiety disorders experienced a reduction in symptoms, particularly when anxiety was linked to autonomic dysregulation (Rauch et al., 2021). The calming effects of SGB on the sympathetic nervous system make it a compelling option for refractory cases of anxiety.

Headaches (Migraine and Cluster Headache)

Headaches, particularly migraines and cluster headaches, are often linked to dysregulation of the autonomic nervous system. Research indicates that SGB may alleviate pain and reduce the frequency of these headaches. A small clinical trial demonstrated significant reductions in migraine attacks following SGB, likely due to its modulation of the cervical sympathetic plexus, which influences cranial vasculature (Narouze, 2010). Cluster headaches, a type of trigeminal autonomic cephalalgia, have also responded favorably to SGB in case studies, with reports of reduced severity and frequency of attacks (Kumar et al., 2023).

Hyperhidrosis, is characterized by excessive sweating. It affects approximately 2-5% of the population worldwide, with focal hyperhidrosis (e.g., palms, soles, and axillae) being the most common form (Doolittle et al., 2016). It often begins in adolescence or early adulthood and can significantly impact quality of life. Treatment options include topical antiperspirants, systemic anticholinergics, botulinum toxin injections, and emerging interventions such as stellate ganglion block.

Hyperhidrosis

Hyperhidrosis, characterized by excessive sweating, often results from overactivation of the sympathetic nervous system. SGB has been explored as a therapeutic option for focal hyperhidrosis, particularly in the upper extremities. Case studies suggest that SGB can effectively reduce sweating in patients with hyperhidrosis resistant to topical or systemic therapies (Candido et al., 2019). By inhibiting the sympathetic outflow, SGB provides a targeted and reversible treatment for this condition.

Complex Regional Pain Syndrome (CRPS)

CRPS is a debilitating pain condition associated with abnormal sympathetic nerve activity. SGB is a well-established treatment for upper extremity CRPS, with studies showing significant pain relief, improved range of motion, and enhanced functionality after treatment (Jadon et al., 2017). SGB disrupts the pain-amplifying cycle mediated by the sympathetic nervous system, making it a cornerstone of CRPS management.

Certain Abnormal Heart Rhythm Conditions

For patients experiencing life-threatening arrhythmias, particularly electrical storm (recurrent ventricular tachycardia or fibrillation), SGB has emerged as a life-saving intervention. A systematic review found that SGB reduces the burden of ventricular arrhythmias, stabilizing cardiac rhythms and improving survival rates in patients with refractory electrical storm (Meng et al., 2023).

Long COVID Symptoms

Long COVID, a post-viral syndrome, often includes symptoms such as fatigue, brain fog, and loss of smell (anosmia). Recent case reports suggest that SGB may improve anosmia and other autonomic symptoms associated with long COVID (Kumar et al., 2023). While promising, these findings warrant further investigation through controlled studies.

Hot flashes and other vasomotor symptoms (VMS) affect approximately 60-80% of women during menopause, with an average duration of symptoms lasting around 7.4 years, though some women experience them for over a decade (Freeman et al., 2015). VMS prevalence peaks during the late perimenopausal and early postmenopausal stages, significantly impairing quality of life for many. Treatment options include hormone replacement therapy (HRT), non-hormonal medications (e.g., SSRIs, gabapentin), lifestyle modifications, and emerging interventions like stellate ganglion block for those seeking alternative or adjunctive therapies.

Hot Flashes and Menopause-Associated Symptoms

SGB has been explored as an alternative treatment for vasomotor symptoms, including hot flashes and night sweats, commonly experienced during menopause. A randomized controlled trial found that SGB significantly reduced the frequency and intensity of hot flashes in menopausal women, especially those unable or unwilling to use hormone replacement therapy (Lipov et al., 2018). This intervention may also benefit women with surgically induced menopause or breast cancer survivors with hormone-sensitive conditions.

Conclusion

Stellate ganglion block offers a versatile and minimally invasive approach to managing diverse conditions linked to sympathetic nervous system dysfunction. Its applications range from psychiatric conditions like PTSD and anxiety to chronic pain syndromes, autonomic dysregulation (e.g., hyperhidrosis), and even menopausal hot flashes. While the evidence is robust for some conditions, such as CRPS and PTSD, others require further validation through large-scale, randomized controlled trials.

About the Author

Dr. David George maintains a clinical practice at Neuregen Integrative Psychiatry and Neurologic Health Clinic and Research Center in Scottsdale, AZ. Renowned for his innovative approaches, including co-inventing a medical device that was granted FDA's first 'Breakthrough Medical Device' designation for the treatment of acute Migraine, Dr. George employs stellate ganglion block alongside therapies like ketamine therapy, medical hypnotherapy, neuromodulation, physiotherapy, and modern psychotherapeutic techniques to address complex psychiatric and neurologic conditions. His multidisciplinary approach reflects a commitment to innovative, cutting-edge, and evidence-based care.

References

Candido, K. D., Massey, S. T., Sauer, R., & Knezevic, N. N. (2019). Emerging roles of stellate ganglion block in the treatment of post-traumatic stress disorder. Current Pain and Headache Reports, 23(8), 1–9. https://doi.org/10.1007/s11916-019-0796-6

Hanling, S. R., Hickey, A., Lesnik, I., Hackworth, R., & Liebert, M. (2016). Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry, 73(6), 567–574. https://doi.org/10.1001/jamapsychiatry.2016.0502

Jadon, A., Sinha, N., Chakraborty, S., & Agrawal, R. (2017). A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of upper extremity. Indian Journal of Anaesthesia, 61(1), 33–38. https://doi.org/10.4103/0019-5049.198400

Kumar, N., Pandey, R. K., & Bhattacharya, A. (2023). Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions. Journal of Anaesthesiology Clinical Pharmacology, 40(2), 165–172. https://doi.org/10.4103/joacp.joacp_40_23

Lipov, E., Joshi, J. R., & Lipov, S. (2018). Stellate ganglion block improves menopausal hot flashes: Case series. Journal of Women’s Health, 27(9), 1122–1124. https://doi.org/10.1089/jwh.2017.6543

Meng, L., Tseng, C. H., Shivkumar, K., & Ajijola, O. A. (2023). Efficacy of stellate ganglion block in treatment of electrical storm: A systematic review and meta-analysis. Scientific Reports, 13, 1234. https://doi.org/10.1038/s41598-023-28456-7

Narouze, S. N. (2010). Interventional management of migraine headaches: Current and emerging therapies. Pain Practice, 10(3), 222–230. https://doi.org/10.1111/j.1533-2500.2009.00358.x