For most of his life, Isaiah Heller has oscillated between panic and prescriptions, alcohol, and marijuana to numb difficult emotions and a mind that “moved at 100 miles a second.”
The U.S. Army veteran tried to take his own life twice. He couldn’t keep a job, and his driver’s license was once revoked after he suffered a trauma-induced seizure disorder. He attempted—but walked out of—cognitive processing therapy, a specialized clinical treatment to reframe past events and gain emotional freedom.
Heller suffered from shame and trauma due to experiences in foster care, a near-death hate crime assault as a young teen, and sexual abuse in the military. But his silent suffering echoed in the walls of his own home with night terrors, paranoia, and his inability to be present—psychological symptoms that bled into the lives of his wife and children.
And then, one day, these symptoms came to a grinding halt; his nervous system relaxed like a rubber band that loses tension. He was miraculously present and at peace when he walked out of the Joy Wellness Partners clinic after getting his first stellate ganglion block (SGB).
“It was almost like the weight of the universe lifted up off my body. It was such a euphoric feeling,” he said. “I am getting time back in my life because I’m enjoying the moment.”
Trauma isn’t rare. Heller is among the 6 percent of the population that experiences post-traumatic stress disorder (PTSD)—about 12 million adults in a given year. At some point in their lifetime, half of all adults will have trauma, a shocking event witnessed or that happens to them.
SGBs are simple procedures that take minutes, involving an anesthetic injected into the stellate ganglion, a bundle of nerves in the cervical spinal column associated with the sympathetic nervous system.
Guided by sonogram imagery, a physician inserts a small needle of medicine that temporarily dulls this starburst of nerves connecting the body to the brain. The block lasts for about eight to 10 hours with a similar mechanism as an epidural, which blocks sensation from the belly button to the upper thighs for pregnant women in labor.
It’s a well-established procedure anesthesiologists have used for a century for pain. A case report of PTSD in 1990 inspired its “off-label” use for trauma.
In most cases, SGBs offer instantaneous relief to burdened nervous systems that have become stuck in “fight-or-flight.” But rocky reviews and murkiness over its mechanism have stalled wide acceptance of the procedure. Research hasn’t pinpointed why it doesn’t reboot everyone’s nervous systems. Also, among those who enjoy its benefits, the longevity of the reset varies extensively. It may last a decade or only a few months, with no foreknowledge on factors that make it more effective.
“Certain people just don’t respond to the block, and we don’t know why,” Dr. Eugene Lipov, pain specialist and early pioneer of the procedure, told The Epoch Times. Lipov—the chief medical officer for Stella clinics across the United States, Australia, and Israel that offer the procedure—said his research includes looking into genetic and other explanations for differences in patient response.
How SGB Works
It’s theorized that the reason SGBs work is because they reset the nervous system to its state before the trauma. The sympathetic nervous system is a component of the autonomic nervous system that’s designed to unite the brain and body for effortless, instantaneous responses to threats, whether physical or emotional.
Dr. Frank Ochberg, a pioneer in trauma science, has petitioned for years to reclassify PTSD as post-traumatic stress injury (PTSI) because improved brain scans now reveal that trauma can be healed, boosting the validity of biological interventions such as SGB. He argues a change in name could remove the stigma attached to trauma and better allow the injured to seek help.
One simple theory is that SGB works by calming the nervous system. The cervical sympathetic trunk is the link between the body and the brain, holding polysynaptic neurological connections from the stellate ganglion leading to the amygdala, the part of the brain associated with anxiety and trauma.
Another hypothesis is the injection could be suppressing nerve growth factor, which lowers norepinephrine and mutes physiological symptoms like rapid heart rate, shallow breathing, sweaty palms, and brain fog. The activation of the fight-or-flight system elevates norepinephrine in the brain, a neurotransmitter that leads to arousal, selective attention, and vigilance.
Those with PTSD have high levels of norepinephrine in their cerebrospinal fluid. High norepinephrine symptoms are associated with sleep dysfunction, impulsivity, anxiety, depression, and sexual dysfunction.
Finally, additional evidence indicates SGB might work as a sedative due to the reduction in norepinephrine. The nervous system then “boots up” back at baseline.
Assessing Risks and Side Effects
Until the development of fluoroscopy, SGBs were performed by using vertebrae as landmarks to guide the injection. Now, sonograms are used for the procedure, which lowers many risks by helping doctors guide the needle to the anterior lateral C6 vertebrae and allowing them to watch the administration of medication using dye.
Risks associated with SBG include a small chance of infection. There are very rare occurrences of the injection hitting a blood vessel and forming a hematoma, which is why it’s not done on those taking blood thinners. Temporary side effects such as droopy eyes or a hoarse voice are common.
Prevalent, but rarely a significant problem, is the rush of emotions and memories that happens after the procedure. Heller believes the effect is what enabled him to talk about his trauma and process it in healthy ways. He re-entered therapy, this time successfully. Eight weeks in, he told his wife about the sexual abuse.
“That was a breakthrough for me, and I never thought I was ever going to get there. It doesn’t affect me anymore,” Heller said. “It’s crazy what you can do when you’re in the right phase of mind.”
The number of clinics specializing in SGBs is growing, as are non-profit organizations that offset costs. A mix of studies and proponents claim a success rate claim of about 75–90 percent. But while some patients rave about the results, it isn’t always a one-and-done fix.
Dave Conley, U.S. Navy veteran and founder of One More Day Inc., is a pragmatic advocate. Focused on the prevention of veteran and military suicide, One More Day helps connect veterans to The Stellate Institute, run by veteran physicians Drs. Sean Mulvaney and James Lynch, among other providers.
“You’ve got to still put the work in,” said Conley, who had an SGB followed by two weeks of intensive PTSD therapy in 2022. He lost four friends to suicide after they returned from serving. After his own attempt at taking his life, he started the organization and then a podcast.
Conley’s nightmares eased up significantly after his SGB. He said the procedure stirs a lot of excitement, but people should be wary of false hope. Many need a follow-up procedure, oftentimes because of re-exposure to new trauma or intense triggers.
Heller opted for two follow-up procedures after a car accident introduced new stress. His experiences overall have motivated him—to find a job he loves, dig into his school work, and enjoy every moment with his three children.
“People that say they want to change, they act on it. I’ve worked for everything I’ve gotten,” Heller said. “This is my life, and it’s amazing.”
That tenacity to stick with therapy is a key component of the SGB success story, Conley said. He was ready to quit after three days, but by the second week, it all began to click.
A randomized study of 113 active military personnel published in 2019 in JAMA found a significant improvement in symptoms in the group that had SGB. The author wrote that the procedure buoys therapy for patients with barriers to cognitive-based therapies because of concentration and hyperarousal issues, which can affect the brain’s ability to function normally.
“Specifically, encoding and retrieving memories or integrating new learning becomes very challenging,” wrote Kristine L. Rae Olmsted, a behavioral epidemiologist whose focus is military mental health. “As a psychologist who has deeply collaborated with physicians who provide SGB, I have observed that many of the insights discussed prior to SGB have been more easily applied following the procedure.”
Conley believes the use of this novel trauma treatment could expand dramatically, though SGBs haven’t garnered sweeping support from governmental agencies. Doctors have spent years seeking more veteran access to SGBs, but legislation to expand the treatment option—the Treat PTSD Act—died in committee during the last two congressional sessions.
The bill would require the Department of Veterans Affairs and the Department of Defense to provide SGBs for qualified military and veterans, as well as updating clinical practice guidelines to include it as a PTSD treatment option. Support has come from both sides of the aisle.
There’s another hiccup in SGB’s history. A study published in 2016 Regional Anesthesia and Pain Medicine—a double-blind, randomized controlled trial—concluded there’s no evidence to support SGB for PTSD. The study, authored by Dr. Steven Hanling who didn’t reply to a request for an interview, “did not demonstrate any appreciable difference between SGB and sham treatment on psychological or pain outcomes.”
However, a Department of Defense analysis that looked at this study and the 2019 JAMA study noted that the 2016 study “had a number of methodological limitations, including high attrition, absence of key outcomes, and deviance from commonly used administration techniques for SGB.” The 2016 study also had a smaller sample size of 42 participants while the 2019 study that found evidence of efficacy had 113 participants.
The 2019 study also had its own issues, including a lack of blinding of treating physicians, meaning they knew which patients got the real treatment. There was also a possible unblinding of participants due to side effects of SBG, meaning some patients may have figured out if they got the real treatment or the sham treatment.
Proponents have questioned the reliability of the 2016 study in light of other evidence, including an analysis published in 2021 of 205 patients that showed 90 percent responded positively to the procedure. Of the 20 who didn’t receive a reset, 10 had the procedure done on the other side of their neck, and nine of those patients had a favorable outcome.
Lipov admits the limited acceptance of SGB could simply be because it’s a “weird concept,” a disruptive use of technology that doesn’t fit medical training and thinking. His career pivoted to focus on it only because of his own observations of its efficacy.
Patients who want an SGB must pay out-of-pocket, which can limit the market size for interested physicians. But the treatment may also rub up against the pharmaceutical industry, which sells billions of dollars in drugs used for PTSD and anxiety disorders.
“The main problem it’s not accepted I think is there’s no pharmaceutical dollar behind it,” Lipov said. “There’s no patent on the drug, and the distribution process is a complex undertaking.”