Frequently Asked Questions on SGB Treatment for PTSD
Is SGB painful?
It is not painful. Most patients rate it 0-2 on the 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 physician, is is very easy to tolerate as a patient.
Is stellate ganglion block covered by health insurance?
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.
What are the risks of SGB?
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.
How long does it take to complete an SGB injection?
Once we have you in our procedure room and have cleaned your skin with special soap, the procedure takes about 10-20 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.
How long will stellate ganglion block help with PTSD?
While SGB is not effective for everybody, if it works for you it can last many weeks to years and in many 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.
Will SGB interfere with my psychological therapy?
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.
What are the normal side effects of the SGB procedure?
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. Your arm on the treated side may become warm and flushed with more blood flow than usual. You may have a runny nose. All these are NORMAL 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.
Do I have a medical problem that will prevent me from having an SGB?
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.
Can I repeat the SGB procedure?
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.
How do you monitor the success of the SGB procedure for PTSD?
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.