Post-traumatic stress disorder (PTSD) is a complex mental illness that can have a profound negative impact on virtually all areas of a person’s life. Depending on the nature and severity of a person’s symptoms, PTSD treatment typically involves various types of therapy along with certain prescription medications.
But therapy and medication may not be the only elements of care that can help people whose lives have been disrupted by this disorder.
A brief medical procedure that has been used for nearly a century to treat pain and related conditions may offer an alternative path to relief from PTSD symptoms. Considerable research over the past two decades indicates that this procedure, which is known as a stellate ganglion block, may offer significant benefits to people who have PTSD.
What Is the Stellate Ganglion?
The stellate ganglion, which may also be referred to as the cervicothoracic ganglion, is a group of nerves that is located at the base of the neck, near the voice box, between the C6 and C7 vertebrae. These nerves are often arranged in an oval or star-like shape.
The stellate ganglion is part of the sympathetic nervous system. This network is closely associated with the body’s “fight or flight” response. As described on the Cleveland Clinic website, the sympathetic nervous system can trigger the following responses when a person perceives that they are in danger:
- Increasing the size of pupils to enhance vision
- Elevating heart rate to deliver more oxygen to various body parts
- Relaxing airways to improve flow of oxygen to the lungs
- Slowing the digestive process so that energy can be diverted elsewhere
- Extracting additional energy from stored substances in the liver
The neurotransmitters acetylcholine, epinephrine, and norepinephrine are essential to the functioning of the stellate ganglion and other parts of the sympathetic nervous system.
What Is a Stellate Ganglion Block?
A stellate ganglion block is a brief outpatient procedure that involves an injection of local anesthesia directly into this nerve cluster. This procedure is typically performed by a trained physician with the assistance of a nurse.
- The patient who is receiving the stellate ganglion block procedure usually lies on an exam table.
- The doctor who is providing the treatment may use an ultrasound probe or fluoroscope to locate the stellate ganglion.
- Once the stellate ganglion has been located, one of the treatment providers will apply a small amount of local anesthetic to numb the site where the injection will occur.
- The doctor will inject then inject the anesthesia into the identified location.
- The entire procedure typically takes no more than 30 minutes.
In the immediate aftermath of the procedure, some patients experience side effects such as drooping eyelids, bloodshot eyes, a hoarse voice, or difficult swallowing. These effects usually disappear within a few hours.
The stellate ganglion block is not a new technique. The first one in the United States occurred in the 1920s. According to an August 2022 article on the website of the National Library of Medicine, healthcare professionals have used stellate ganglion blocks to diagnose and/or treat a variety of medical conditions, including:
- Complex regional pain syndrome of the head and upper limbs
- Peripheral vascular disease
- Chronic post-surgical pain
- Raynaud disease (numbness in extremities)
- Scleroderma (an autoimmune disease that causes joint pain and skin tightening)
- Orofacial pain
- Phantom limb pain
- Atypical chest pain
- Cluster headaches
- Vascular headaches
In some cases, people who receive stellate ganglion blocks for pain or other medical conditions experience relief after one or two injections. Others may need as many as 10 stellate ganglion blocks to achieve lasting benefit.
How Stellate Ganglion Blocks Help People with PTSD
The first report of the successful use of a stellate ganglion block to treat PTSD was published in the June 1990 edition of The Clinical Journal of Pain. Over the ensuing decades, many other researchers have explored how this procedure can help people who have posttraumatic stress disorder.
A December 2019 article on the Cornell Pain Clinic website offered two hypotheses to explain how stellate ganglion blocks treat PTSD:
- The stellate ganglion is connected to the amygdala (two regions near the center of the brain that are associated with functions such as memory, fear, and aggression). The amygdala may be particularly active in people who have developed PTSD. A stellate ganglion block reduces the nerve impulses and messages that are sent to these brain regions, which minimizes PTSD symptoms.
- People who have PTSD increases in nerve growth factor, which leads to an abundance of norepinephrine in the central nervous system. The elevated levels of this neurotransmitter can, in turn, lead to more intense PTSD symptoms. A stellate ganglion block may suppress nerve growth factor, which prevents the production of additional norepinephrine and lessens PTSD-related distress.
In November 2019 article about a study on using stellate ganglion blocks to treat military members with PTSD, the study’s co-leader reported that blocking nerve impulses seems to be central to this procedure’s effectiveness. She also acknowledged that additional research is necessary to ascertain how, exactly, stellate ganglion blocks achieve their effects.
“The stellate ganglion is like a routing center for the nervous system and controls the impulse for fight or flight,” Kristine Rae Olmsted, MSPH, said in the article. “Anesthetizing the ganglion blocks nerve impulses temporarily. We still don’t know how [a stellate ganglion block] works to improve PTSD symptoms, but now we know that it does.”
The Effectiveness of Stellate Ganglion Blocks in PTSD Treatment
In addition to exploring the mechanism by which a stellate ganglion block impacts PTSD symptoms, researchers have also worked to determine how effective this procedure is. Several studies indicate that many people who receive a stellate ganglion block experience measurable improvements and speak positively about the procedure.
For example, here are a few highlights from the study that we referenced at the end of the previous section, which explored the benefits of stellate ganglion blocks to treat PTSD in military personnel:
- This study involved 113 active-duty service members who had symptoms of PTSD.
- 74 subjects were randomly selected to receive stellate ganglion blocks. The other 39 subjects received a placebo.
- The research team used the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) to evaluate the study subjects over a period of eight weeks.
This research effort yielded the following results:
- The mean change in CAPS-5 scores after eight weeks was greater among the subjects who receive stellate ganglion blocks than among those who received the placebo.
- The subjects in the stellate ganglion block group had a mean reduction of -12.9 points on the CAPS-5 assessment.
- Study subjects who had higher CAPS-5 scores at the outset had the largest improvements.
- The subjects in the sham treatment group had a mean reduction of -5.8 points on the CAPS-5 assessment.
- Six of the study’s subjects had adverse reactions, but none were deemed to be serious.
Overcoming Stigma & Improving Attitudes Toward Treatment
Kristine Rae Olmstead, who co-led the study that we referenced in the previous section, noted that the benefits of stellate ganglion blocks weren’t limited to symptom reduction. She noted that the procedure also helped some subjects adopt a healthier attitude toward further treatment.
“Some people described the treatment as opening a door,” Rae Olmstead said in the November 2019 article about the study. “Some felt significantly less anxious even when they thought about the trauma, so they were then able to do the talk therapy willingly and effectively.”
The findings of Rae Olmstead’s team were consistent with those of a pilot study on stellate ganglion block treatment for PSTD that appeared in the July-August 2021 issue of the journal Military Medicine. This study was conducted by Air Force Maj. Richard Odesso, DNP, MPH, RN, and Lorene Petta, PsyD, BCB, CC-AASP.
Odesso’s and Petta’s study involved 35 active-duty service members with PTSD symptoms, all of whom had deployed to a combat zone within the prior 24 months.
- The subjects, all of whom received stellate ganglion blocks, consistently reported a 23%- 25% reduction in PTSD symptoms during three screenings over a three-month follow-up period.
- At the end of the three-month screening period, only one study subject had not achieved relief from at least one PTSD symptom.
- The beneficial effects of the stellate ganglion blocks appeared to peak and then plateau after three months.
As Rae Olmstead mentioned in the article about her team’s study, Odesso and Petta also noted that stellate ganglion blocks appeared to increase subjects’ willingness to participate in additional treatment for PTSD.
“[Stellate ganglion blocks] exhibited success in both rate and level of response, reduced stigma relative to acceptance of the treatment, and [service members] verbalized a high perceived value of the treatment,” Odesso and Petta wrote.
Considering the unfortunately prevalent stigma that is attached to mental health treatment within the military, this increased willingness of service members to engage in therapy may indicate a considerable secondary benefit to stellate ganglion treatment for PTSD. As Odesso and Petta reported, studies suggest that as many as 60% of military personnel who experience mental health challenges fail to report their concerns due a fear of negative responses from their peers.
“The most significant benefit of the [stellate ganglion block] appears to be its ability to act as a gateway to treatment and to facilitate active participation and compliance by the [service members] during its ‘window’ of efficacy,” they added in the conclusion to their report.
Gianna Melendez
Jodie Dahl, CpHT