Stellate ganglion block

Domain IX · Biomedical, neuro & digital

What it is

SGB is an image-guided anaesthetic injection near a cluster of sympathetic nerves in the neck. It is done by a physician (in the trials, physicians in interdisciplinary pain management centres) in an outpatient setting. It has long been used for complex regional pain syndrome, migraine and hot…

Format

• Format in trials: a short outpatient course of procedures at a pain management centre, alongside the participants' usual PTSD care. Participants were on stable medication. Frequency and dosing are left to the treating physician and are not described here.
• Earlier Navy trial (Hanling et al. 2016; first presented as a 2015 pain-medicine conference poster led by McLay): 42 service members. Symptoms improved in both groups, with no significant difference between SGB and sham. The lead author suggested earlier positive reports might reflect placebo…

Who practises it, and how they are trained or regulated

• Version followed: stellate ganglion block (SGB) as an off-label, adjunctive procedure for PTSD, as evaluated in the US Army sham-controlled trial (Rae Olmsted et al., 2020, JAMA Psychiatry) and as described by US military/VA, Australian DVA and Canadian CADTH evidence documents; regulatory and service status as of October 2026 (checked 16 October 2026) per the sources listed. Delivery is described at a descriptive…
• Ongoing and later trials: a VA multisite, triple-blind, placebo-controlled trial (Lim et al., Contemporary Clinical Trials, December 2025; NCT05169190) with a sham arm, an untreated arm and an objective startle measure. A registered trial of SGB to augment trauma-focused therapy in veterans (NCT05107752). A protocol for SGB to prevent PTSD after emergency eye-trauma surgery (Gao et al. 2025, Frontiers in Medicine).…
• Stella: clinics in several US states, plus "Certified" partner sites, market SGB and a branded variant called "Dual Sympathetic Reset" (DSR). The PTSD page relies on testimonials ("relief came quickly", and an "immediate and positive impact"). It cites an internal responder-based patient study and calls its treatments "proven". It says nothing on regulatory status or off-label use. The only side effect mentioned is…

Evidence status, as the guide reports it

• Who delivers what: the physician or procedural team handles eligibility, consent for the procedure itself, delivery and medical follow-up. The psychotherapist handles psychoeducation, decision support, ongoing psychotherapy, monitoring and safety planning.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• fragmented care between private clinics and public services.
• repeated procedures standing in for engagement with psychotherapy.
• shaming the client for being interested. Keep curiosity and respect.
• pinning everything on one procedure. Hope that collapses can raise risk.
• relapse when effects fade. A quick, dramatic change in either direction is a cue to check risk.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.