Stellate Ganglion Block (SGB)
Some people with PTSD have done everything right. They’ve gone to therapy. They’ve tried the medications. They understand, in their heads, that the danger is over. But their bodies never got the message. Their hearts still race at a sudden noise. They still scan every room for the exits. They still lie awake at 3 a.m., wired and exhausted at the same time. A stellate ganglion block, or SGB, was built for exactly this problem. It doesn’t work on thoughts or memories. It works on the body’s alarm system itself.
An SGB is a short medical procedure that helps calm the body’s alarm system. The stellate ganglion is a small bundle of nerves in the lower part of your neck. It’s part of the system that controls your “fight or flight” response — the racing heart, tense muscles, and constant sense of danger that can take over after trauma or long-term pain. During an SGB, a trained provider uses ultrasound to guide a small injection of lidocaine anesthetic near these nerves. The medicine quiets their activity, turning down the volume on a stress response that has been stuck in the “on” position for too long. For many people, this acts like a reset, giving the body a chance to remember what calm feels like. At Kismet, we use SGB to treat both PTSD and chronic pain, often alongside therapy and our other services, so the relief it brings can become the foundation for deeper, lasting healing.
The Science of How It Works
Your brain and your body are always talking to each other. The nerves in your neck are like a busy highway that carries messages between them. When trauma or long-term pain keeps you on edge, that highway gets jammed with stress signals. Your body tells your brain there’s danger. Your brain believes it and sends even more stress signals back. The cycle feeds itself.
An SGB interrupts that cycle. SGBs appear to calm a stress chemical process tied to nerve growth, and they also change how the body releases stress hormones. When those signals settle, the brain’s fear center gets a break. It can shift into a healthier way of working, and it often stays there long after the medicine is gone.
The research is growing. A 2025 review that combined many studies found that SGB helps ease PTSD symptoms, and it may help with the anxiety and depression that often come with trauma. The largest study of its kind found strong improvement across many types of traumas, in both military members and civilians.
Another important study followed 166 patients who received SGB for PTSD. Six to nine months later, nearly three out of four of the patients who were checked still showed meaningful improvement, with many reporting significantly reduced symptoms at the twelve-month mark. Researchers have also noticed that people with the most severe PTSD often respond the most.
What the Procedure Is Like
You lie back comfortably. The skin on your neck is numbed first. Then the provider uses ultrasound to see exactly where the medicine needs to go. Ultrasound is now considered the gold standard for this procedure because it shows the area much more accurately than older X-ray methods. Each injection takes only a few minutes.
The approach depends on what we’re treating. For PTSD, we target two sites on one side of the neck. Treatment usually starts on the right side, since research has found the right side works best for most people, and fewer than 5% of patients need a left-side block if the right side doesn’t help. For chronic pain, we target two sites on each side of the neck — four sites in total.
Right after the procedure, you may notice a droopy eyelid, a small pupil, or a warm or stuffy feeling in your face. These are expected signs that the block is working. They begin to fade within about 30 minutes.
Why SGB Works Best With Other Support
SGB quiets the alarm. It doesn’t put out the fire.
We see this every day at Kismet. Many of the people who walk through our door have tried therapy before, and it didn’t go deep enough. That’s rarely because they didn’t try hard enough. It’s because their bodies were stuck on high alert the whole time. It’s hard to face your trauma when your nervous system is screaming at you to run. SGB can turn that noise down enough for real healing work to begin.
Researchers are starting to test this idea. A recent pilot study paired SGB with an intensive, one-week course of trauma therapy. People in the study saw large improvements in their PTSD and depression — whether they got SGB or a placebo. That tells us something we already believe deeply: good trauma therapy is powerful on its own. SGB isn’t meant to replace that work. It’s meant to make it more possible for people whose bodies have been standing in the way.
That’s why SGB at Kismet is never a stand-alone fix. It’s one piece of a larger plan built around you. Our trauma therapists are trained in approaches like EMDR, Brainspotting, ART Therapy (Accelerated Resolution Therapy), and Internal Family Systems. These methods help your brain process what happened, and they tend to work best when your body feels safe enough to stay present. SGB can help create that safety. It can also sit alongside ketamine infusions, Ketamine-Assisted Psychotherapy (KAP), and psychiatric med management. Our team talks to each other, so what happens in one room supports what happens in the next.
And as always, nothing is required. You can come to us for SGB alone. You can add therapy later, or never, although addressing the root causes of a trauma is always recommended.
SGB for Chronic Pain
If you live with chronic pain, you know it’s about more than the body part that hurts. It’s the sleepless nights. It’s the plans you cancel. It’s the slow wearing down of your patience, your mood, and your hope. Many of our clients have tried medications, physical therapy, and injections, and they’re still hurting. SGB offers a different path, because it works on the nervous system that keeps the pain going.
Here’s why that matters. Long-term pain can put your nervous system on overdrive. Over time, it becomes extra sensitive and starts turning up the volume on pain signals. Researchers call this central sensitization. Surprisingly, it shows up in both PTSD and chronic low back pain, and it’s linked with conditions like fibromyalgia and complex regional pain syndrome (CRPS). SGB calms the stress side of the nervous system, which can ease that oversensitivity. That’s also why SGB fits so naturally at Kismet. Pain and trauma often travel together, and they feed off each other. Treating one can help the other.
The research is encouraging. A review that combined studies on arm and hand CRPS found that SGB improved both pain and the ability to function, with only short-term, self-limiting side effects and no long-term complications. A recent study across different pain types found the biggest improvements in people with migraines and CRPS. Almost two out of three migraine patients had their pain cut by half or more. SGB has also been used for nerve pain after shingles, headaches, and facial pain.
Where Kismet stands apart is what happens around the block. SGB can quiet the pain enough for you to start living again. Our integrated team helps you build on that relief. Ketamine infusions are another option for stubborn pain, working through a different pathway in the brain. Our psychiatric med management prescriber can review your current medications and look for better options. Our trauma therapists can help with what chronic pain carries with it — the fear of the next flare-up, the grief over the life pain has taken, and any trauma that may be feeding it. Your providers talk to each other, so every part of your care points in the same direction.
Trauma, Inflammation, and Autoimmune Conditions
Trauma doesn’t only change how you feel. It can change how your immune system behaves. When the body’s alarm system stays switched on for months or years, it keeps releasing stress hormones and chemical signals that cause inflammation. In short bursts, inflammation protects you. It’s how your body heals a cut or fights off a cold. But when it never shuts off, the immune system can get confused and start attacking the body’s own healthy tissue. That’s what an autoimmune disease is, and it includes conditions like rheumatoid arthritis, lupus, psoriasis, and Hashimoto’s thyroiditis. Researchers keep finding this link. A large Swedish study of more than 100,000 people found that those with PTSD and other stress-related conditions were more likely to develop autoimmune diseases later on (Song et al., JAMA, 2018). A study of U.S. veterans found the same pattern (O’Donovan et al., Biological Psychiatry, 2015), and adults who went through more trauma as children are more likely to be hospitalized for autoimmune disease (Dube et al., Psychosomatic Medicine, 2009). This is where SGB may help. The stellate ganglion is part of the same stress system that keeps inflammation going. By quieting it, SGB may lower the stress signals that keep the immune system on edge, and some early studies have found lower markers of inflammation after the procedure. But we want to be honest with you: this research is still young. SGB is not a treatment for autoimmune disease itself, and it doesn’t replace care from your rheumatologist or other specialists. What it may offer is relief on the stress side of the problem, so your nervous system stops pouring fuel on the fire.
Care Tailored to Who You Are
Trauma looks different depending on where it came from and who you are. So does good care. The procedure itself stays the same, but everything around it — how we prepare you, who supports you, and what comes after — can be shaped to fit your experience.
Veterans. Most of the SGB research has been done with military members, and that’s where the evidence is strongest. Combat trauma often shows up as constant hypervigilance, poor sleep, and a hair-trigger startle response — the exact symptoms SGB seems to help most. We understand military culture, and we know many veterans have already tried the standard options.
First responders. Police officers, firefighters, paramedics, and dispatchers carry the weight of call after call. Many are wary of traditional therapy. One counselor who works only with first responders told CBS News that this group tends to be more resistant to traditional therapy than civilians. SGB can be a good starting point because it doesn’t require you to talk through every call. It works on the body first. Therapy can follow when and if you’re ready.
Sexual violence survivors. For survivors of sexual assault or abuse, the procedure itself deserves extra care. Lying back, being touched, and having someone near your neck can bring up real fear. We take this seriously. You’ll know every step before it happens. You choose who is in the room. You can pause or stop at any time. There’s also early evidence that benefits can last for this group.
Women. PTSD affects women more often than men. Women are diagnosed more often, and the risk is especially high after interpersonal trauma such as sexual violence and domestic abuse. Yet much of the early SGB research focused on men in the military. We think women deserve care designed with their experiences in mind — including preparation, provider choice, and follow-up support that fits their lives.
Anyone carrying an overwhelming past. You don’t have to be a combat veteran or a first responder to benefit from SGB. Trauma doesn’t only come from war zones or emergency calls. It can come from a car accident, a painful divorce, a medical crisis, the sudden loss of someone you love, or years of growing up in a home that never felt safe. Sometimes it’s one terrible day. Sometimes it’s a long series of hard things that slowly wore you down. Whatever the cause, your body can respond the same way, getting stuck on high alert long after the danger has passed. SGB works on that stuck alarm system, no matter what set it off. You don’t need to prove your story was “bad enough” to deserve relief. If life has overwhelmed you and your body hasn’t been able to settle since, a SGB may help. During your consultation, we’ll listen to what you’ve been through and help you decide whether it’s the right fit for you.
Frequently Asked Questions
SGB at Kismet serves two groups of people: those living with PTSD and those living with chronic pain. These conditions may look different on the surface, but they share something underneath. In both, the nervous system can get locked into a pattern of overreacting, and SGB helps break that pattern. When treating PTSD, we place the medicine at two points on one side of the neck. When treating chronic pain, we work on both sides, placing medicine at two points on each side for a total of four. During your consultation, you and your provider will explore the best approach for you.
Most people describe it as much easier than they expected. The numbing medicine stings for a second or two, a lot like a quick bee sting or a flu shot. After that, most people feel pressure rather than pain. Many notice a spreading warmth in their face, neck, or arm on the treated side, and some say their eye or face feels a little heavy. It's also common to feel a lump in your throat or a slightly hoarse voice for a few hours. Some people feel a wave of calm settle over them within minutes. Others feel emotional, even tearful, as their body lets go of tension it has held for a long time. Both are normal. We'll be with you the whole time, being reassured and guided.
Some people feel a shift within hours or days. For PTSD, the first thing many notice is that their body feels calmer — less jumpy, less on guard, better able to sleep. For chronic pain, many notice their pain easing. Others see changes more gradually. How long results last varies from person to person. Research suggests PTSD benefits can last six to twelve months for many people. For others, symptoms slowly return, and a repeat block may help.
When performed by a trained provider using ultrasound, SGB has a strong safety record. One military pain center reviewed 250 SGB procedures for PTSD and found no immediate or delayed complications. Temporary side effects like a hoarse voice, a droopy eyelid, or a warm face are common and pass within hours. Serious complications are rare.
No. SGB works on your nervous system, not your memories or your story. You don't have to describe what happened to you to receive it. For many people — especially those who find traditional talk therapy hard to start — that's a big part of the appeal. SGB can calm the body first. Therapy can come later when you're ready. Psychotherapy is never a requirement at Kismet, but it is highly recommended for long-lasting relief because it addresses why the symptoms are present to begin with.
Yes, and for many people that combination makes the most sense. SGB turns down the body's alarm system. Ketamine and trauma-focused therapy help with the deeper work of processing what happened. When your nervous system isn't constantly on high alert, it can be easier to engage fully in therapy. The same is true for chronic pain, which often travels together with trauma, depression, and anxiety. Our team coordinates across services, so your providers know what you're working on and how the pieces fit together.
SGB for PTSD, which targets two sites on one side of the neck, is $1,500. SGB for chronic pain, which targets both sides of the neck at four sites, is $2,250. Insurance often doesn't cover these costs; unfortunately, SGBs are considered off label. We can provide superbills to you for reimbursement if your plan allows for this procedure, but we don't bill insurance for you. We also accept Health Savings Accounts and Flexible Spending Accounts.
SGB isn't a good fit for everyone. Certain bleeding problems or blood-thinning medications, an infection near the injection site, and some heart or lung conditions can make the procedure unsafe. We'll review your full medical history and current medications during your intake. For PTSD, SGB tends to help most with the body-based symptoms — hypervigilance, poor concentration, and sleep problems — so if your struggles look different, another approach may serve you better. We are here to help create a treatment plan that is best tailored to what your history is, what your physical body and nervous system needs and how to care for you as a unique individual who is looking for ways forward.