The Stellate Ganglion Block

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

This week I had the pleasure of sitting down with Dr. Michael Wilkinson—a renowned pain physician, Oak Ridge native, and veteran—to discuss a truly fascinating and promising procedure: the stellate ganglion block. While this block has been used for years to treat complex pain syndromes, Dr. Wilkinson shared how it is now being used for far more, including the management of PTSD, anxiety, depression, certain migraine syndromes, and even symptoms of long COVID. What stood out is just how effective and rapid-acting this treatment can be for conditions that are not only common in our community but are also hard to manage with traditional medications.

Dr. Wilkinson explained that the stellate ganglion is a bundle of nerves in the neck that interacts deeply with the brain’s “fight or flight” centers, including the amygdala and insula. By temporarily shutting off the stellate ganglion via a straightforward lidocaine injection, the heightened state of alert many patients experience with PTSD or anxiety is allowed a much-needed “reset.” The results, he shared, can feel immediate—many veterans have described the sensation as comparable to the sudden relief of taking a Valium. Notably, the procedure is not lengthy or complex, often taking less than a minute to perform, and can provide meaningful relief not only for those with psychological trauma, but also for people suffering chronic pain, migraines, and post-COVID symptoms.

PODCAST NOTES 

• The stellate ganglion block, which has been a standard but under-the-radar treatment for complex regional pain syndrome, was found somewhat by accident to have a profound benefit on PTSD symptoms in wounded soldiers at Walter Reed during the Global War on Terror. As doctors were performing this nerve block for pain, they noticed their patients’ psychological symptoms were simultaneously improving—so much so that now thousands of these procedures have been performed on active-duty military personnel with documented positive outcomes.

• This block targets a group of nerves in the neck that’s connected to the amygdala and insula—the “fight or flight” centers of the brain that become hyperactive in people with trauma. By delivering a small dose of lidocaine to this bundle via a precise ultrasound-guided injection, doctors can temporarily disconnect the nerve’s input, which calms the brain circuits responsible for anxiety, hypervigilance, and panic, creating space for the nervous system to recalibrate.

• The effects can be astonishingly fast and potent. Patients often report a calm, tranquil, almost instant change—some describing a sensation akin to taking a fast-acting anti-anxiety drug like Valium. In practice, this has meant that even those overwhelmed by PTSD or severe generalized anxiety have been able to feel relief in a matter of minutes, not days or weeks, marking it as a uniquely rapid intervention.

• Usually, the stellate ganglion block protocol consists of a series of three treatments administered every two weeks, after which intervals lengthen to every three to six months or as clinically indicated. Rather than aiming for endless treatments, the goal is to do as few as possible—just enough to help patients regain control over symptoms and allow ongoing recovery through therapy or other support.

• Dr. Wilkinson emphasized that the spectrum of benefit is broadening—he’s successfully treated not just combat PTSD, but also panic attacks, generalized anxiety, hard-to-control depression, certain stroke-like migraine syndromes, and even symptoms lingering after COVID-19 infection or vaccination. For some, like a young man crippled by anxiety or migraine sufferers with debilitating symptoms, this block has been a life-changing option when standard treatments failed.

• We also spent time discussing the striking connections between early psychological trauma and persistent, difficult-to-treat medical conditions. Chronic pain, autoimmune diseases (like MS and rheumatoid arthritis), and fibromyalgia often have roots in unresolved early life or childhood trauma, with studies showing that these life experiences can literally enlarge and sensitize the amygdala, trapping the body in a cycle of pain, depression, and anxiety.

• The stellate ganglion block offers a compelling alternative to ketamine infusions, which are increasingly used for severe depression and chronic pain but require prolonged administration, cause dissociation and hallucinations, and often necessitate multiple medications. Compared to ketamine, stellate ganglion block is quick, straightforward, has fewer side effects, and emerging studies suggest it may be as—if not more—effective for many patients dealing with psychological and pain disorders.

• Shockingly, despite its everyday use in the military for active-duty service members, the VA system still does not officially recognize or offer the stellate ganglion block as a PTSD treatment, even though their patient population arguably needs it the most. This lack of accessibility stands in contrast to mounting clinical data, powerful patient stories, and the ongoing expansion of medical research, all arguing that the procedure should be considered a mainstream, front-line option for trauma care.

The growing body of experience and clinical evidence for the stellate ganglion block signals a major shift in how we can approach persistent psychological and chronic pain conditions—especially in those for whom talk therapy and medications have fallen short. 

If you or someone you care about has been struggling with anxiety, PTSD, depression, stubborn migraine, or lingering symptoms from COVID-19, don’t settle for the status quo. Ask your provider about the stellate ganglion block or seek out specialists who are up to date on the latest advances in pain and trauma care. Let’s keep spreading the word, advocating for more research, and pushing for greater access to all evidence-based treatments.

Stay educated. Stay healthy. 

Till next week.