Unfortunately, some people we see with chronic pain have experienced traumatic or anxiety-provoking events in the past. Despite the best psychological care and medications, unfortunately, some people find their elevated ‘fight or flight system remains active, and it can be tough to control their levels of anxiety and distress – affecting many aspects of their lives.
There is a system in our body that controls fight or flight decisions – we call this our sympathetic nervous system. This system can make our heart race, our chests tighten, and our bodies can become sweaty in certain situations. These situations, such as places, memories, or smells, may relate to previous trauma or, in some people, can occur without warning.
These symptoms can lead to an unhelpful cycle. We get triggered by something, and then we experience the symptoms of panic/fear/flight – but then those symptoms trigger us to stress about our actual symptoms, causing our hearts to race even more. These symptoms, making us stressed even more, can become an unhelpful cycle of panic and make life difficult.
A Stellate Ganglion block is a procedure we perform at Resolve Pain to assist people with these symptoms. These sympathetic nerves run from your chest to your brain and carry these ‘danger’ signals. The procedure is designed to temporarily break the cycle of these signals going to your brain by blocking the transmission of nerve signals through this system using a local anaesthetic (a numbing agent).
The procedure may also be recommended if you have more complex pain, such as upper limb chronic regional pain syndrome or some types of cancer. However, your healthcare team will discuss these details with you if required.
If you choose, the procedure is performed with you awake, slightly sedated, or almost entirely asleep. Different people either want to be completely asleep while others don’t like the sensation of sedation - and we will always do our best to accommodate your needs and keep you as comfortable as we can.
The procedure is what we call a day procedure. We have you come into the hospital in the morning, and we place a small drip in your arm. We lie you on a theatre bed and use a small needle to numb (anaesthetise) the skin (this slight sting is often the most uncomfortable part). Then, under ultrasound guidance, we advance a needle gently into the side of the neck to the right spot and inject a small amount of local anaesthetic around the stellate ganglion nerve fibres. We often do this in two locations. Then we remove the needle and move you to the recovery area.
You may find your vision slightly blurry and your voice slightly hoarse for a few hours - this is normal, and if these happen, it helps confirm that we were in the right spot (but these symptoms don’t happen for everyone, even if we were in the right place!)
If the procedure works well for you, and you have a sense of calm and reduced anxiety or mood symptoms, then we often repeat the procedure within a few weeks after the first to help the effect last as long as possible.
There are stellate ganglions on both sides of the neck. Sometimes, like being Right or Left-handed, one side may be more important for you than the other. In 80% of people, the right side is the most important, so we recommend that side first. If the procedure doesn’t work for you, we can offer to try the other side on another day to see if the other side is more dominant for you.
Will this definitely work for you? Sadly, like many things in life, we cannot guarantee improvement. As everyone is very different, there are often various reasons for your symptoms. If the stellate ganglion and sympathetic system are contributing to your symptoms, then there is a good chance that this procedure may be of assistance. If it is not, then this procedure may be less effective for you. Many patients have found this procedure very helpful in controlling their symptoms.
Research is limited on who is most likely to gain a benefit, and different studies have shown various degrees of success compared to other therapies. However, the procedure can be performed carefully, and many patients find it a beneficial addition to their other treatments to help improve their quality of life and help them function daily.
Are there any risks to the procedure? Yes. We always perform the procedure in a sterile surgical manner and under imaging guidance such as ultrasound. However, we cannot always predict everyone’s slightly different anatomy.
The common risks are tenderness and bruising at the site, which often settles with simple analgesia or cold packs. Very rare but possible risks include injury to blood vessels, nerves, or the spinal cord. These could theoretically lead to seizures or death - but these risks are all exceedingly rare.
Some people ask if we can do both sides at the same time. Unfortunately, we can’t for safety reasons. If you were to have trouble with a blood vessel on one side of the neck, you still retain a good supply from the other side. But if both sides were done and in the extremely unlikely event both were injured, it could lead to a stroke (where your brain does not get enough blood temporarily and gets damaged). So, we cannot do both sides at once for your safety.
You can talk to your health team at Resolve Pain if you have further questions. There is also additional information below if you want to learn more *These are external links and we so cannot endorse all their content*