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.”
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.
“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.”
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.
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.
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.”
Lives Changed
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.
“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.
Broader Reach
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 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.
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.