Between September 2020 and March 2023 I had 12 Stellate Ganglion Blocks (SGBs) as a treatment for my Complex PTSD caused by severe Developmental Trauma. Two SGBs were with Pulsed Radio Frequency Ablation (pRFA). This minimally-invasive and largely safe procedure has been used to treat PTSD for about 10 years. It shows remarkably impressive results with long-lasting and even permanent relief.
An SGB gives the nervous system the opportunity to recalculate the threat level and down-regulate if appropriate. It’s like giving your nervous system a chance to pause, look around, and see whether there’s still a threat. So when current environment is low stress, more downregulation is likely.
I was initially doubtful because studies are largely on young vets with PTSD from war, rather than older people with Complex/Developmental Trauma. However, I had the pleasure of speaking with Dr. Eugene Lipov, who developed the procedure for PTSD. He told me that in his experience “hypervigilance is hypervigilance.” Effectiveness depends on individual response, “how much trauma they’ve had and how long they’ve had it.” He felt with my complex and compounded trauma I had about a 50% chance of success.
The good doctor was right! Each treatment gave my nervous system the opportunity to downregulate or recalculate my threat level. Aside from tinnitus and chronic muscle tension, all other symptoms were dampened. Access to my prefrontal cortex (PFC) increased, energy and spirits rose, and pretty much everything was easier. For about two weeks. This is a fraction of the usual 1-3 month relief.
Symptom Creep and Ongoing Trauma
At about 14 days “symptom creep” came on rapidly and my functionality went down in seemingly equal measure. During the first treatment gap of 35 days, my condition quickly deteriorated until the last two weeks I was near death and very near death. I could barely force my body to keep the appointment for SGB #2.
Fortunately, though I am a difficult/complex case, the SGB treatments still seem to “build on each other” as others describe. Gradually, my baseline anxiety level has gone down, as has the level of ambient pain. This is a great relief!
It occurred to me that ongoing traumatic events are a significant factor in my SGB effectiveness window. I might have a better response to SGB if I could focus only on healing my nervous system instead of dealing with continuing trauma. I can’t control most things, but I can avoid some triggering things.
Medical Trauma Hiatus = Forward Motion
After two particularly bad experiences with new providers, which heavily triggered me and caused me great dissociation, I determined it best to suspend all medical interactions except those with providers I can trust to not trigger/harm me. I canceled all others for the next 3 months, including consults, tests, and screenings, even my dental check-up. That let me focus exclusively on healing my nervous system as much as possible.
Ultrasound or Flouroscope?
According to Dr. Sean Mulvaney, its best to use the ultrasound instead of the flouroscope. My doctor agreed. He said the ultrasound allows him to visualize the soft tissue rather than follow the bone. This makes for accurate placement of the needle for maximum beneficial effect. Evidently many providers don’t have the experience to perform SGB with ultrasound guidance. My most recent 3 procedures were performed under the flouroscope. (Which produces super cool images, so if you can, take a pic of the screen!)
How to find SGB for PTSD?
I found my SGB doctor by asking all my providers for help finding SGB. I didn’t know at the time that a pain specialist or anesthesiologist could give the shot. I thought it had to be somebody super special. No, my pain specialist has given hundreds of SGBs even before mine. It’s just that I was his first patient asking for it for PTSD.
Ask your primary care, others doctors, nurses, anybody you can think of, and search on the internet for “sgb near me” and “stellate ganglion block near me” because you never know what you might find if you do that.
I recommend you familiarize yourself with Dr Mulvaney’s protocol, “Clinical Guidelines for Stellate Ganglion Block to Treat Anxiety Associated With Posttraumatic Stress Disorder,” and give that to prospective providers to help them understand what you’re looking for and that it’s not some whim.
It took a year of lobbying and searching for me to get my first SGB. You have a leg up with this information, especially that anesthesiologists can do it, as well as knowing about the Mulvaney protocol.
You won’t know until you have an SGB how much relief you will find. If you find the procedure at least as helpful as I do it will be worth your effort to seek them.
Good sources of more info about SGB for PTSD:
You might have to educate your doctor like I did. He hadn’t done it for PTSD before. I gave him the protocol from Dr Sean Mulvaney in Annapolis
Dr. Eugene Lipov’s Stella Center offers some good background info on SGB for PTSD. However, the site tends to overhype the benefits, such as asserting the shot will “reset the ANS,” when it does not. This can cause disappointment for sufferers. Cost for the procedure at a Stella Center is high and often involves travel.
Dr. Sean Mulvaney’s site, which provides a FAQ
Also from Mulvaney, “Clinical Guidelines for Stellate Ganglion Block to Treat Anxiety Associated With Posttraumatic Stress Disorder,” which my pain specialist found particularly informative.
In addition: “Comparison C6 Stellate Ganglion versus C6 and C4 Cervical Sympathetic Chain Blocks for Treatment of Posttraumatic Stress Disorder (PTSD): Analysis of 147 Patients”
DISCLAIMER: This is not medical, psychological, pharmaceutical, or legal advice. The contents of this site represent Shay Seaborne, CPTSD’s lived experience and understanding of the neurobiology of trauma through study and experiences.