We are excited to discuss the use of Stellate Ganglion Block (SGB) for Post Traumatic Stress Disorder (PTSD). SGB is effective 85% of the time with patients obtaining an average of 50% improvement in their PTSD almost immediately. We offer this treatment in Seattle and Bellevue, Washington.

In the Media

Click the “play” button to watch three recent broadcasts about SGB for PTSD from “60 Minutes” and “CBS This Morning” and “The Joe Rogan Experience.” These videos feature brave patients who share their stories as well as the two pioneers in the use of SGB for PTSD; Sean Mulvaney, MD and Eugene Lipov, MD.

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is a mental health condition characterized by a heightened response to a traumatic event. A alternate term for this condition is Post Traumatic Stress Injury (PTSI). This can result in feelings of persistent stress, anxiety, and fear, even when there is no immediate danger present. Those who suffer from PTSD often avoid situations that remind them of the traumatic event or place and may experience flashbacks. These flashbacks can be as real as the moment they occurred.

PTSD can develop from any type of traumatic experience, either physical or emotional. PTSD is not limited to military and law enforcement service. It is often treated with various forms of therapy, medication, and at times, stellate ganglion block (SGB) injections. SGB for PTSD has recently gained worldwide attention due to the TV program “60 Minutes.”

Symptoms of PTSD

Intrusive memories

Symptoms of intrusive memories may include:

  • Recurrent, unwanted distressing memories of the traumatic event
  • Reliving the traumatic event as if it were happening again (flashbacks)
  • Upsetting dreams or nightmares about the traumatic event
  • Severe emotional distress or physical reactions to something that reminds you of the traumatic event


Symptoms of avoidance may include:

  • Trying to avoid thinking or talking about the traumatic event
  • Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

  • Negative thoughts about yourself, other people or the world
  • Hopelessness about the future
  • Memory problems, including not remembering important aspects of the traumatic event
  • Difficulty maintaining close relationships
  • Feeling detached from family and friends
  • Lack of interest in activities you once enjoyed
  • Difficulty experiencing positive emotions
  • Feeling emotionally numb

Changes in physical and emotional reactions

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

  • Being easily startled or frightened
  • Always being on guard for danger
  • Self-destructive behavior, such as drinking too much or driving too fast
  • Trouble sleeping
  • Trouble concentrating
  • Irritability, angry outbursts or aggressive behavior
  • Overwhelming guilt or shame

For children 6 years old and younger, signs and symptoms may also include:

  • Re-enacting the traumatic event or aspects of the traumatic event through play
  • Frightening dreams that may or may not include aspects of the traumatic event
What is a Stellate Ganglion Block (SGB)?

The stellate ganglion is a bundle of nerves that is located deep in the lower neck. It is located within the cervical sympathetic chain. Sympathetic nerves play a strong role in our fight-or-flight response. When you have PTSD, these nerves malfunction and are constantly sending distress signals to your brain and body. Injecting local anesthetic (numbing medicine) around these nerves is called a stellate ganglion block (SGB). SGB resets these nerves that are chronically in fight-or-flight response. This is similar to rebooting your computer; after the “SGB reboot,” your nerves function normally. Stellate ganglion block (SGB) injections need to be performed under either ultrasound and/or fluoroscopic guidance as there are major blood vessels and organs nearby. The SGB injection is not new and has been used for 100 years to treat painful conditions such as chronic regional pain syndrome (CRPS) of the upper extremity. More recently, SGB is being used to treat PTSD.

The Stellate Ganglion Block (SGB) Procedure for Post Traumatic Stress Disorder (PTSD).

The Stellate Ganglion Block (SGB) Procedure for Post Traumatic Stress Disorder (PTSD).

The only physicians that are formally trained in the SGB procedure are Interventional Pain Management physicians (MDs and DOs). We learn how to safely perform SGB during a year-long advanced training program called a Pain Medicine fellowship. A fellowship is the highest level of training a physician can complete and is done after four years of medical school, one year of internship, and three years of residency. Even then, the SGB technique used for PTSD treatment is more complex than when used for painful conditions and in many cases requires even more refinement after fellowship. For example, SGB used for PTSD treatment is done under ultrasound at two different levels and great care is taken to ensure a proper Horner’s syndrome after the SGB procedure. This is rarely the case in a standard SGB procedure when used for pain. Stellate ganglion block is a technically demanding procedure that requires precise image guidance using an ultrasound machine and sometimes a form of x-ray called a fluoroscope. We always prefer to use ultrasound as it allows us to better visualize nerves, arteries and veins in this delicate area.

You may wonder why some physicians use ultrasound while others use fluoroscopy. The answer is fairly simple; it is much safer and accurate to use ultrasound but much more difficult to learn this method. Fluoroscopy is faster but does not allow for the visualization of delicate nerves and blood vessels in the area. The procedure is non painful, as it involves only a single needle poke in the side of the neck after numbing the skin. Typically, we will first perform SGB on the right side of your neck, as medical studies have found the right side to be most efficacious in most people. However, less than 5% of patients may require an SGB on the left side of the neck if they do not respond to a properly performed right sided SGB procedure. If you are visiting us from far away, we will typically schedule a right SGB followed by a left SGB on a subsequent day to ensure that you have the best opportunity for optimal outcomes. For safety reasons, we do not treat both sides on the same day. In our clinic, we have top of the line ultrasound machines and flouroscopy available. With rare exception, we prefer to perform this procedure under ultrasound guidance.

Be careful; you may find professionals such as naturopathic physicians (NDs) or nurse practitioners (ARNPs or DNPs) offering this procedure. They are unqualified to perform this procedure. They will do their best to hide their lack of training in interventional pain management procedures from you. These professionals complete no formal hospital-based residency nor fellowship in performing pain management procedures. It is dangerous for NDs or NPs to attempt to perform complex interventional procedures such as a stellate ganglion block. If you are looking for a professional to perform this procedure on you, be sure they are a physician (MD or DO) and have completed medical school, internship, formal hospital-based residency and especially a one year long accredited Pain Medicine fellowship. Some physicians with Sports Medicine fellowship training are also qualified to do this procedure. You can check if your physician is a board certified physician at the American Board of Medical Specialties website. Only then are they qualified to safely perform this procedure.

This video from Drs. Escolar and Amador demonstrates the anatomy and technique involved with this specialized procedure:

How Effective is the SGB?

The severity of PTSD can be measured using a psychological intake called the PCL-5. The PCL-5 is a well known and standard test used by mental health professionals such as psychiatrist and psychologists. A reduction of 10 points or more is considered a meaningful change in the mental health profession; meaning if your mental health professional sees a 10 point drop in your score, a treatment can be considered successful.  Using the two level SGB technique in which the injection is performed at both C6 and C4, SGB is successful in approximately 85% of patients who see an average of 50% reduction in their symptoms. This is a mean reduction in the PCL-5 score of over 30 points (Dr. Mulvaney, et. al.). Consider that an SGB procedure takes only around 30 minutes to complete, and compare this to months or years of conventional therapy and medications.

Recent Research

Several studies have been performed in the past, analyzing the effectiveness of stellate ganglion block (SGB) for the treatment of PTSD. Although results were favorable, the level of research was not ideal. Very recently, however, the first multi-site, randomized control trial was published by the Journal of the American Medical Association (JAMA). The results show that two stellate ganglion blocks two weeks apart help reduce symptoms related to PTSD. You may read the study here:

A 2022 study was published by Drs. Lipov et. al. This study tracked 327 patients who had received a stellate ganglion block for PTSD. This showed that patients benefited from an average reduction in the PCL score (PTSD severity score) of 29 points. A reduction of 10 points is considered clinically significant in the medical field. It also showed that virtually all causes of PTSD responded to the Stellate Ganglion Block procedure equally well (for example, sexual assault, physical violence and combat trauma survivors all had similar improvements; the cause of PTSD does not effect the outcome of a SGB procedure).

Drs. Lynch & Mulvaney et. al. surveyed multiple mental health clinicians including psychiatrists and psychologists. They found of those behavioral health clinicians with personal experience incorporating SGB into their trauma- focused psychotherapy, 95% of respondents would recommend SGB to a colleague as a useful tool for the treatment of trauma-related disorders. SGB was rated at least as useful as the most valuable interventions listed in the American Psychological Association Clinical Practice Guideline for the Treatment of Post-traumatic Stress Disorder with 100% of respondents characterizing SGB as ’Very Beneficial’ or ’Somewhat Beneficial:

Our SGB Experience

Dr. Attaman has performed SGB procedures for over 12 years, initially for painful conditions and then for PTSD. He has performed hundreds of SGBs specifically to treat PTSD. Dr. Attaman was elected as a Seattle Magazine “Top Doc” in Pain Medicine for 2019, 2022, and 2023. He was elected by other physicians as a Seattle Met “Top Doc” in Pain Medicine for 2015, 2016, 2017, 2018, 2019, 2020, and 2021.

Take-Home Message

PTSD is a life-altering problem for anyone who has suffered a major traumatic event in their lives. PTSD is not limited to military trauma. Stellate ganglion blocks have shown promising results in recent studies and those who suffer from PTSD are encouraged to discuss the SGB procedure with a qualified physician. If you have PTSD and feel that you are stuck, or that you have worked very hard in therapy but have reached a plateau that you cannot pass, or feel the physical symptoms of PTSD such as tension, difficulty taking a deep breath, or racing heart will not improve, SGB may be a very good option for you. It is also important to know these injections are just one component of the treatment regimen and that continued therapy under the direction of a mental health care professional is beneficial as well.

It ranges from not painful to minimally painful. Most patients rate it 0-2 on a 10 point pain scale for a few seconds. First, we numb your skin with local anesthetic using a needle the thickness of an acupuncture needle. Then, we precisely guide a very thin needle using an ultrasound machine to the target, which is not very deep in your neck. While this procedure is technically complicated to perform for your pysician, is is very easy to tolerate as a patient.
Your initial consultation and follow up exams are covered by most insurances. However, the SGB procedure itself is not covered by insurance when used to treat PTSD.
SGB has been performed for almost one hundred years (really!) to treat various conditions. Therefore we have a large set of data to evaluate safety. SGB is very safe if performed by a fellowship-trained and board-certified Pain Medicine subspecialist physician such as Dr. Attaman. There is a less than 1 in 1000 chance of any serious negative side effects. Although extremely rare, such side effects can include allergic reaction, temporary or permanent nerve damage, paralysis, internal bleeding, hematoma formation, infection/abscess formation, puncture of the spinal cord or its surrounding layers, spinal fluid leakage with possible headache, stroke, seizure, respiratory distress, pneumothorax, hoarse voice, palpitations, heart attack, difficulty swallowing, local anesthetic toxicity with neurologic and cardiac defects, and procedure failure. Please note, if this procedure is performed by a Naturopathic Physician (ND), Nurse Practitioner (ARNP or DNP) or Physician’s Assistant (PA), it should be considered unsafe as these professionals cannot obtain the advanced training required to safely perform this procedure.
Once we have you in our procedure room and have cleaned your skin with special soap, the procedure takes about 10-30 minutes to complete. Most of this time is spent scanning your neck with our ultrasound machine to find the ideal target location. The actual time our needle is in your neck is a few minutes.
While SGB is not effective for everybody, if it works for you it can last many months to years and in some cases can be permanent. SGB can be repeated as needed, if needed, in the future. There is no limit to how many you can have. If you have had positive benefit from an SGB in the past, but you feel your PTSD symptoms returning, it is better to repeat the SGB sooner rather than later when the symptoms may become stronger.
Absolutely not! SGB helps to remove the physical symptoms you experience from PTSD such as a racing heart, sweating, hypervigilance, and generalized body tension. Once these physical symptoms are reduced by SGB, you may find you and your psychologist or counselor can make great progress with therapy.
A successful SGB block will cause your face to look a little strange for a few hours, and cause you to have some interesting symptoms. You will have a droopy eyelid, your eye will become blood-shot. Your voice may be hoarse. you may feel as if you have a lump in your throat. Your arm on the treated side may become warm and flushed with more blood flow than usual. You may have a stuffy nose. All these are expected and not reason for concern. These side effects will go away later in the day or over night. You may also have a headache similar to a migraine, or feel like you cannot take a deep breath with your belly muscles on the treated side. These are not dangerous and will resolve.
If you have allergy to our medications, acute or chronic lung disease, active infection in the area, have had extensive surgery in the front of your neck, or are on blood thinners that you cannot safely stop, you may not be a candidate. We will fully evaluate all of these issues with you in person during a consultation in our clinic. Please do not stop your blood thinners without consulting with your prescribing physician first to discuss the risks.
Yes! As long as it helped you initially, you may repeat it as often as you need. There is no limit. We may also try a left sided SGB if you’ve had good but suboptimal relief from a right sided SGB.
We follow a protocol to measure the strength of the SGB block developed by Dr. Mulvaney; 1. Immediately after the procedure, we will grade the success of your SGB procedure by assessing the amount of eyelid drooping, the degree of your bloodshot eye, and how much your pupil contraction has changed. If it appears the SGB was not successful in producing a strong result, we will usually repeat the procedure the same day to ensure a good sympathetic block. 2. We ask that you continue to see your mental health professional during and after the SGB procedures. 3. We will administer a psychological screening test called a PCL-5 after your SGB procedure to see if your symptoms have improved in a measurable way.
Dr. Attaman is board certified and Anesthesiology-fellowship trained in the medical subspecialty of Pain Medicine and Interventional Pain Management. He is also residency trained and board certified in the specialty of Physical Medicine and Rehabilitation. He is one of only a few with such extensive qualifications in the state of Washington. Connect with Dr. Attaman on Google+ | LinkedIn | Facebook If you are in pain, call Dr. Attaman's Seattle office (206-395-4422) or Bellevue, WA (425-247-3359) office.


  1. Annie F. 03/13/2020 at 6:16 AM - Reply

    I had a failure of the right SGB (higher and lower areas of the neck) at another clinic. Has success been seen in left side blocks?

    • Jason G. Attaman, DO, FAAPMR 11/17/2020 at 11:16 PM - Reply

      Hello Annie,

      I’m sorry to hear your right sided SGB did not help. Was it performed by a fellowship trained Pain Medicine physician? There are few physicians performing this procedure in the United States using the proper technique and protocols.

      In less than 5% of patients, the SGB will fail to help with PTSD when performed on the right side but will work when performed on the left side. The exact reason for this is unknown, but there are other anatomic variations in human anatomy consistent with this.

      A left sided SGB is likely a very good option. Best, Dr. Attaman

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