Since September 2020, I have undergone 25 Stellate Ganglion Blocks (SGBs) as a treatment for Complex PTSD, quadrilateral Complex Regional Pain Syndrome (CRPS), dysautonomia/ Postural Orthostatic Tachycardia Syndrome (POTS), and other sympathetic conditions. These are caused by severe Developmental Trauma, exacerbated by psychiatric and surgical abuse from the people and institutions I turned to for help. Three SGBs were enhanced with pulsed Radio Frequency Ablation (pRFA), four were bi-level, and one was on the left. This minimally invasive and safe procedure has been used to treat PTSD for over 10 years. It shows remarkable results with long-lasting and even permanent relief.
An SGB allows the nervous system to recalculate the threat level and down-regulate if appropriate. It’s like giving the nervous system a chance to pause, look around, and see whether there’s still a threat. So when the 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 allowed my nervous system to recalculate my threat level and downregulate some. Aside from tinnitus and chronic muscle tension, all other symptoms were dampened. Access to my prefrontal cortex (PFC) increased, energy and spirits rose, and 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!
I discovered 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.
Medical Trauma Hiatus = Forward Motion
After two particularly negative 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 Fluoroscope?
According to Dr. Sean Mulvaney, ultrasound is superior to fluoroscopic imagery for administering SGBs. My first pain specialist agreed. He said the ultrasound allows him to visualize the soft tissue rather than follow the bone. This allows accurate placement of the needle for maximum beneficial effect. Many providers don’t have the experience to perform SGB with ultrasound guidance. This is why most of my procedures were conducted under the fluoroscope. (This produces super cool images, so if you can, take a pic of the screen!)
How to find SGB for PTSD?
I found my three SGB doctors 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. My pain specialist has given hundreds of SGBs. I was only his first patient asking for the shot for PTSD.
Ask your primary care, other doctors, nurses, and 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.
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 since anesthesiologists can do it, and you know about and can share the Mulvaney protocol.
You won’t know until you have an SGB how much relief it can bring. 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 Dr. Sean Mulvaney’s “Clinical Guidelines” (link below), which he found helpful.
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. The 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”
RESOURCES
In-depth video by Dr. Micah Burns on the Stellate Ganglion Block (SGB), including anatomy, side effects, and more.
SGB for Vets helps spread awareness.
Operation First Response sometimes has funds to cover the cost of an SGB at the Stellate Institute in Annapolis.
Stellate Ganglion Block Treatment For PTSD At VA. The VA is not big on SGB (it is wedded to the old model that treats it like a “disorder”) but some vets may be able to obtain one. “Veterans who are enrolled in Department of Veterans Affairs (VA) care can contact
their mental health provider for more information about SGB. SGB is sometimes
used to treat pain, and some VA facilities may offer it in that context.”
For the Love of a Veteran offers assistance with SGB treatments for vets.
Erase PTSD Now “provides accessible treatment for people facing the challenges of Post Traumatic Stress Disorder (PTSD) ~ ESPECIALLY VETERANS.”
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.