Today we commune to talk about the stellate ganglion! A portion of the body and your nervous system located in the neck which has direct implications for PTSD treatment. AND indirect uses for downstream PTSD symptoms like painful somatizations. Something I hadn’t heard of before getting the tip-off from our community Fucker ThePlanetsDreamer / Somber Mercy.
But don’t take our word for it. Let’s first hear from:
Stellate Ganglion Block for Post-traumatic Stress Disorder: A Comprehensive Review of Evidence, Technique Considerations and Symptom Outcomes in Military and Non-Military Patients
Thomas Bielawiec1 · Brittany Melvin1 · Bhuvaneswari Sandeep Ram1 · Magdalena Anitescu1
Current Psychiatry Reports
2026
Thanks to the medical community finally acknowledging “PTSD” rather than “shell shock” or “personal weakness,” targeted therapies have been rapidly improving. We no longer recommend generalized SSRIs or one-size-fits-all interventions, but instead use multidisciplinary treatments to tackle the myriad causes and symptoms.
One of those modern treatments is the stellate ganglion block.
SGBs involve injecting anesthetic between cervical vertebrae (vertebrae in your neck) to stunt the activity of the stellate ganglion. The stellate ganglion, itself, refers to the fusion of the cervical and thoracic ganglions. This area contains the nerve interchange between the brain, upper limbs, and head, and is known to hold a central role in sympathetic nervous system activation (that’s your fight or flight response).
The SGB is foreign to most of us, but it’s been used since the 1940s to treat depression. In the 1990s it was first utilized for PTSD in conjunction with medication and traditional therapy. In the 2000s it became a subject of scientific research, finally exploring these anecdotal and clinical connections.
Though the SGB procedure has been used for PTSD, pain, heart arrhythmias, and other nervous system aberrations, the mechanisms by which it is effective are currently (say it with me) unknown to medical science. One theory is that the block reduces nerve growth factor and nerve growth, which can then decrease neurotransmitters and nervous system activity.
These authors conducted a review of prior publications on the SGB to seek answers.
And they found…
Results/Discussion of their review.
The majority of previously published research on SGBs confirms that it’s an effect treatment for PTSD, including in non-military applications. The largest study on the topic reports that over 80% of patients experienced “significant improvement” of symptoms. Other research indicated anywhere from 50 to 70 to 96% efficacy across patients in reference to clinically decreasing their scores on the PTSD checklist of symptoms.
It seems that symptoms are not unilaterally improved, though.
Symptoms like nervous system hyperarousal, reactivity, and avoidance are the most affected symptoms of the stellate ganglion block. Declines in emotional behaviors like numbing, having outbursts, and being irritable are included in these positive changes. Traumatic re-experiencing, however, is not shown to be greatly improved. This means the SGB is not appropriate for treating nightmares, flashbacks, and intrusive memories – but it could help with the resulting emotional and autonomic upsets.
And when it comes to anxiety and depression? Unfortunately, the results are all over the board in the existing literature. Some research found “meaningful improvement for at least a month.” But one study showed no improvement in depression, anxiety, or pain. And two additional cases suggested that a left-sided SGB increased anxiety symptoms, which was improved after a subsequent right-side block.
These results are controversial and may indicate depression and anxiety can’t be knocked out by local anesthesia. But perhaps the most exciting news is, the SGB doesn’t appear to diminish cognitive performance to influence the improvements it more consistently causes. In other words, despite improvements in arousal, emotionality, and reactivity, memory, attentional capacity, and reaction time aren’t stunted overall – a welcome improvement compared to some other treatments that improve PTSD symptomology, but at the expense of broader brain functioning.
Which is welcome relief, when their review also revealed:
Pre-SGB PTSD Severity
The greater the PTSD severity, the greater the improvement caused by the SGB.
And:
Demographics and Trauma Types
The SGB is effective across military and civilian applications. The procedure has been studied most widely in combat and military trauma, but studies including civilians have also reflected meaningful improvements in symptomology, in both men and women. The caveat being that military members indicated greater improvements compared to civilians – which one might hypothesize is due to nervous-system dominant symptoms that come with war experiences. (my words, not theirs).
However, they say:
These studies support that SGB is effective for both genders in both military and non-military populations, irrespective of trauma type.
And they also tell us:
Length of Effect
The results have been validated between 1 day and 6 months. In one study, demonstrating that nearly 3/4ths of patients had significant symptom improvement persisting beyond 3 or 6 months, irrespective of prior PTSD severity. It appears that the results of the block are not fleeting.
And these results might be even more improved by the application of:
Adjunct Therapies
In most research studies, the authors noted that the participants had previously failed to find improvement through standard therapy approaches or received subpar care (let’s be honest, through a facetious lens, and say “probably both!”). However significant improvements post-SGB were seen in patients without previous therapy attempts, as well. Positive results were seen when using SSRIs and psychotherapy in conjunction with the SBG, and with the SGB, alone.
So with that, we hop into the:
Conclusion
The stellate ganglion – a nerve cluster near the cervical and thoracic vertebrate - appears to be related to PTSD symptoms rooted in the nervous system, which can be improved through locally anesthetizing the SG. It is most effective in treating hyperarousal, avoidance, and other unregulated emotional behaviors. With greater symptom severity comes greater improvement, but overall the procedure appears to be effective in men and women, military and civilian applications. Larger trials are underway to better explore the mechanisms of action underpinning these successes to make the non-invasive procedure even safer and more effective. However, it appears to be a promising treatment option, especially in conjunction with other therapies, and when previous therapies have failed.
And with that, I’d like to briefly tell you about another paper that takes this story one step deeper.
You know, unless you’re in the nerdy upper tiers, in which case… we’ve got a lot of detail left to cover.
Let’s talk about:
The connection between the stellate ganglion, PTSD, and chronic lower back pain in a case-study style.
Stellate Ganglion Block for PTSD and Chronic Low Back Pain: A Case Report of Three Veterans
Lindsay Sterling 1, Kristy Fisher 1,2 and AnnaWoodbury 1,2,*
Journal of Clinical Medicine
2025
While SGBs have been used in PTSD applications, they’ve also been applied for chronic pain, including the head, neck, upper limbs, complex regional pain syndrome, chronic myofascial pain, and chronic lower back pain.
The connection being? These authors theorize it’s due to a shared problem underlying both PTSD and chronic pain…. Central sensitization. This would explain why military personal, in particular, are highly responsive to the SGB. Central sensitization is caused by an elevated response in nociceptive pathways (those are sensory nerves responsible for detecting painful, dangerous, or potentially harmful stimulation events) which presents as hyperalgesia (abnormally heightened pain sensitivity) and allodynia (perception of non-painful stimuli as painful). Central sensitization also has ties to the psychosomatic nightmare diagnosis of fibromyalgia.
Underlying central sensitization and PTSD may be anxiety sensitivity. Anxiety sensitivity promotes avoidance of activities that may be painful or perceived as painful, which may limit healthy self-support options. The attentional drain caused by both, resulting energetic drain, and pain as a traumatic memory trigger, may worsen symptoms.
Furthermore, neurostructural changes have been seen in both PTSD and chronic pain patients. On top of prefrontal and hippocampal diminishment, the old amygdala – the part that processes survival threats – is both atrophied and overstimulated in each case. Indicating decision making, memory, and fear responses may be impaired. The immune system is also dysregulated, pumping out and over-uptaking pro-inflammatory signal transmitters – causes of additional pain and disorder.
In other words, there are many reasons to study central sensitization – including the symptoms we accept as “PTSD.” These connected conditions may be attenuated, also, by stellate ganglion blocks, as the SG has connections to the hypothalamus, amygdala, and anti-inflammatory signal transductors.
And in this paper, for a change, we see three clinical case studies describing symptom, procedure, and result.
I’m not going to get into all the details here – that’s for the nerd report – but I can share summaries with you.
Patient 1: 40 year old Female African American veteran suffering from non-responsive PTSD, migraines, chronic low back pain, neck, and arm pain. Previous treatments: SSRIs, prazosin, topiramate, psychotherapy, and trauma-recovery programs; for pain: duloxetine, gabapentin, epidural steroid injections, radiofrequency ablation, and peripheral nerve stimulation. None of which helped with PTSD or pain symptoms. Within one day her pain dropped to 0/10 and PTSD symptoms disappeared. After some recurrence, she was retreated at week 8. One year later she still had reduced PTSD symptoms and no upper limb pain.
Patient 2: 55 year old female Caucasian veteran; history of mental disorder including bipolar, conversion, and PTSD; over two decades of chronic low back pain. Previous laminectomy, non-stimulatory anti-inflammatory drugs, duloxetine, gabapentin, methocarbamol, ibuprofen, topiramate, and epidural steroid injections were not effectively managing her conditions. After SGB her pain and mobility scores increased, and she reported lesser PTSD symptomology, all of which were still observed 7 months after the procedure. However, her lower back pain wasn’t improved.
Patient 3: 29 year old female Caucasian veteran; severe PTSD; chronic low back pain, shoulder pain, and headaches. Previous treatments included physical therapy, medication, epidural steroid injections. Following SGB, headache and shoulder pain scores dropped from 10/10 and 6/10 to 1/10 and 0/10, respectively. Back, headache, and PTSD symptoms were not affected… until one week later. She repeated the SGB procedure and underwent sacral radiofrequency ablation to assist the low back pain, which was more tolerable following the ganglion block. She continues to undergo SGB every 3-4 months to manage PTSD and pain symptoms.
So, three women, ages 29-55, with mixed chronic pain and PTSD, both unresponsive to traditional treatments, underwent SGB and had significant reductions in each category, (sometimes after repeating the procedure), with chronic lower back pain appearing to be the least improved condition in one case.
And in:
CONCLUSION
It seems that central sensitization lies below PTSD and complex regional pain syndrome (chronic pain). Under central sensitization, pain detection and interpretation become artificially heightened by the nervous system, potentially without injury, leading to poorly responsive treatments.
SGB is one of the more promising options for treating central sensitization, PTSD, and chronic pain, and it features few complications or risks. It has been used by Veterans Affairs and in clinical practice to address recurring PTSD; this is now being extended to concurrent non-responsive conditions like chronic low back pain, headache, and upper limb pain. These three case studies in female veterans are another step towards validating SGBs as effective treatments for nervous system hyperarousal, pain anxiety, and inflammation that underscore central sensitization and comorbid PTSD symptoms that haven’t been improved by more traditional therapies.
And with that… I recommend you check out their figure, linking conditions like restless leg syndrome joint disorder, chronic fatigue, GI issues, and pelvic pain to the other ailments we discussed today, through the shared factor of central sensitivity syndromes.