In the largest retrospective study of stellate ganglion block for PTSD to date — 327 patients treated between 2016 and 2020, published in the journal Pain Physician in January 2022 by Lipov et al. — over 80% of patients experienced a clinically meaningful reduction in PTSD symptoms. The average decrease in symptom scores was nearly three times higher than the threshold the National Center for PTSD defines as clinically significant. For the estimated 13 million Americans living with PTSD in any given year, and for Arizona’s nearly 460,000 military veterans in particular, these findings point toward something that traditional therapies alone have struggled to deliver: rapid, measurable relief. At Arizona Pain and Spine Institute in Mesa, Dr. Asim Khan and Dr. Daniel Ryklin offer the stellate ganglion block as part of their approach to treating PTSD and anxiety. Here is what the research shows, how the procedure works, and what patients can realistically expect.

What the Stellate Ganglion Block Is — Through Real Clinical Evidence

The stellate ganglion is a cluster of sympathetic nerves located at the base of the neck near the C6 and C7 vertebrae. These nerves are part of the body’s fight-or-flight system. In a healthy nervous system, this response activates during genuine threats and then subsides. In individuals with PTSD, research indicates this system becomes chronically overactivated — the brain essentially gets stuck in threat-detection mode.

As described in a 2023 review published in Cureus by Kirkpatrick et al., the stellate ganglion is directly connected to the amygdala, a brain region that is abnormally activated in PTSD. A stellate ganglion block (SGB) involves injecting a local anesthetic — typically ropivacaine 0.5% in a volume of 5–10 mL — near this nerve cluster under ultrasound or fluoroscopic guidance. The injection temporarily blocks sympathetic nerve activity, which researchers believe allows the nervous system to “reset” from its hyperactivated state.

The procedure itself is not new. Pain management specialists have performed stellate ganglion blocks for nearly a century to treat conditions like complex regional pain syndrome (CRPS), phantom limb pain, and shingles. What is new is the growing body of evidence — now including a Level 1B randomized controlled trial, the largest-ever retrospective cohort study, and multiple large case series — supporting its use for PTSD and anxiety. Arizona Pain and Spine Institute already lists the stellate ganglion block as a core treatment and treats both PTSD and anxiety as dedicated conditions, making the practice uniquely positioned to offer this emerging application.

Infographic showing how stellate ganglion block interrupts fight-or-flight signals in sympathetic nervous system for PTSD

The Research: From Randomized Trial to 327-Patient Retrospective Study

The JAMA Psychiatry Randomized Clinical Trial (2020)

The landmark study that brought SGB for PTSD into mainstream medical discussion was published in JAMA Psychiatry in 2020 by Rae Olmsted and colleagues. Conducted across three U.S. Army Interdisciplinary Pain Management Centers from May 2016 through March 2018, it was the first multisite, randomized, double-blind, sham-controlled trial of SGB for PTSD — the gold standard for clinical research.

Get Back Your Normal Life Again

As pain specialists, we can guarantee that we are more than qualified in alleviating your pain and treating your condition.

Schedule Treatment
  • Study Population: 113 active-duty U.S. military service members (100 males, 13 females) with clinically diagnosed PTSD
  • Intervention: Two stellate ganglion block injections administered two weeks apart on the right side of the neck at the C6 vertebral level, using 7–10 mL of 0.5% ropivacaine
  • Primary Outcome Measure: Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the gold standard for PTSD assessment
  • Key Finding: The SGB group showed significantly greater reduction in PTSD symptom severity compared to the sham group at eight weeks
  • Level of Evidence: This study established “Level 1B” evidence for SGB as a PTSD treatment, as noted in a 2024 review published in PMC (Mulvaney et al.)

As a 2024 comprehensive review in PMC observed, this trial was significant not just for its results, but because prior SGB research for PTSD “consisted largely of case reports and open-label studies.” The JAMA Psychiatry trial’s sham control and double-blinding gave the findings considerably more weight in the medical community.

The Largest Retrospective Study: 327 Patients (Pain Physician, 2022)

A year after the Kerzner and colleagues systematic review, Lipov et al. published the largest retrospective study of SGB for PTSD to date in the January 2022 issue of Pain Physician. The study analyzed 327 patients treated between December 2016 and February 2020 at an established anesthesia pain clinic. Key findings include:

  • Over 80% of patients experienced a 10-point or greater drop in their PCL (PTSD Checklist) score — the threshold the National Center for PTSD defines as clinically meaningful
  • Average PCL decrease for men: 28.59 points
  • Average PCL decrease for women: 29.2 points
  • These decreases are nearly three times higher than the 10-point “clinically significant” threshold
  • Improvements were statistically significant regardless of trauma type, gender, age over 20, previous suicide attempts, or concurrent psychotropic medication use
  • The study identified 21 different types of self-reported trauma leading to PTSD, demonstrating SGB’s effectiveness across both military and civilian populations

Additional Supporting Evidence

An Australian multi-center study of 99 civilian patients across four cities (Sydney, Brisbane, Perth, and Melbourne) found convergent results: average PCL score decreases of 23.69 for males and 21.64 for females, as reported in the 2024 PMC review by Mulvaney et al.

A 2023 retrospective study of 285 patients by Lynch et al. demonstrated that SGB reduces anxiety — as measured by the GAD-7 (Generalized Anxiety Disorder) questionnaire — by approximately 50%.

A February 2025 study published in Clinical and Translational Neuroscience by Mulvaney and Rae Olmsted examined 75 patients who received bilateral two-level cervical sympathetic chain blocks for PTSD and tracked outcomes across six months. The study’s primary objective was to determine long-term durability of symptom improvement — addressing one of the key gaps in the existing literature.

How Arizona Pain and Spine Institute Delivers the Stellate Ganglion Block

At Arizona Pain and Spine Institute, the stellate ganglion block is performed as an outpatient procedure at the practice’s Mesa and Queen Creek locations. Dr. Khan and Dr. Ryklin bring specialized training in image-guided injections — the same technique used in the JAMA Psychiatry trial to ensure precise needle placement.

Pain management doctor performing stellate ganglion block injection on patient neck for PTSD treatment Arizona clinic

The Procedure Step by Step

Based on the practice’s published treatment information and standard interventional pain management protocols:

  1. Pre-Procedure Consultation: Dr. Khan or Dr. Ryklin conducts a comprehensive evaluation, which the practice states typically lasts 60 minutes or more, to assess the patient’s condition, medical history, and treatment goals.
  2. Day of Procedure: The patient lies on their back. The skin at the injection site on the neck is cleaned and a local anesthetic numbs the area. Using fluoroscopic (live X-ray) or ultrasound guidance, the physician positions a thin needle near the stellate ganglion at the C6 vertebral level.
  3. Injection: A small volume of local anesthetic (typically 5–10 mL of ropivacaine or bupivacaine) is injected around the nerve cluster. The entire injection portion of the procedure typically takes 5 to 15 minutes, according to the practice’s published materials.
  4. Confirmation: Patients are monitored briefly after the procedure. A temporary drooping of the eyelid (Horner’s syndrome) on the injected side confirms the block has reached the target nerves. As noted in the VA Evidence Brief, Horner’s syndrome is “recommended to be quantitatively graded by a third-party medical professional” and typically resolves within hours.
  5. Follow-Up: The practice develops an individualized treatment plan that may include a second SGB injection, consistent with the two-injection protocol used in the JAMA Psychiatry study, along with complementary treatments as appropriate.

Why Precision Matters

The stellate ganglion sits in a complex anatomical area near the carotid artery, jugular vein, and trachea. The VA Evidence Brief specifically recommends “use of image-guidance techniques such as ultrasound, fluoroscopy, or computed tomography to help visualize the injection area” and the availability of “continuous vital sign monitoring technology and resuscitative equipment.” Arizona Pain and Spine Institute’s physicians specialize in precisely these types of image-guided nerve block procedures, performing them routinely for both pain management and emerging applications like PTSD treatment.

Measurable Outcomes — What Patients Can Realistically Expect

Based on the published clinical evidence — not anecdotal claims — the following outcomes have been documented across SGB for PTSD research:

  • Symptom Reduction Speed: The JAMA Psychiatry trial observed measurable CAPS-5 score improvements within two weeks of the first injection. This is considerably faster than the 8–12 weeks typically required for SSRI medications to reach full therapeutic effect, per American Psychiatric Association treatment guidelines.
  • Magnitude of Improvement: The Lipov et al. 327-patient study documented average PCL score decreases of 28.59 (men) and 29.2 (women) — nearly three times the National Center for PTSD’s 10-point threshold for clinically meaningful change.
  • Durability: The February 2025 study in Clinical and Translational Neuroscience by Mulvaney and Rae Olmsted specifically examined six-month durability of bilateral two-level SGB for PTSD, addressing a critical gap in the evidence base.
  • Anxiety Reduction: The Lynch et al. 2023 study of 285 patients demonstrated a 50% reduction in GAD-7 anxiety scores following SGB — relevant given that PTSD and anxiety frequently co-occur.
  • Safety Profile: The JAMA Psychiatry trial reported no serious adverse events. The most common side effect was temporary Horner’s syndrome (eyelid drooping), which resolved within hours. A survey of approximately 45,000 SGBs cited in the VA Evidence Brief reported severe complications at a rate of just 1.7 per 1,000 procedures.
  • Broad Effectiveness: The Lipov et al. study identified 21 different trauma types and found statistically significant improvements regardless of whether PTSD stemmed from military combat, sexual assault, childhood abuse, or other causes.

Important Limitations

Patients should understand several important points. SGB for PTSD is still considered an emerging treatment. As noted in the VA Evidence Brief, PTSD treatment guidelines from the VA/DoD “do not reference SGB” as a first-line recommendation. The injection of local anesthetics for PTSD is considered “off-label” use — which is legal and unregulated, but means it has not received specific FDA indication for PTSD. Not every patient responds the same way; the 327-patient study found that approximately 19% of patients did not achieve a clinically meaningful response. A 2022 study in Military Medicine by Mulvaney et al. found that among 205 patients, approximately 4.4% did not respond to right-sided SGB but did respond to a subsequent left-sided SGB. Long-term data beyond six months remains limited, though the 2025 durability study is helping to address this gap.

Why This Matters for Arizona Patients

Arizona has a substantial population that could benefit from SGB for PTSD. According to the Arizona Department of Veterans’ Services (ADVS) 2024 Benefits Guide, veterans make up 7.5% of Arizona’s population, ranking the state among the top 15 with the highest concentration of veterans. The state has approximately 20,000 active-duty service members, five military installations — including Luke Air Force Base and Fort Huachuca — and approximately 16,000 National Guard and Reserve members.

According to U.S. Census Bureau 2024 American Community Survey estimates, there are approximately 459,818 civilian veterans aged 18 and over living in Arizona. Of these, approximately 52.5% — around 241,343 individuals — served during the Gulf War era (1990–2001) and Post-9/11 era (2001–present). The National Center for PTSD estimates that 11–20% of veterans of Operations Iraqi Freedom and Enduring Freedom experience PTSD in a given year, which translates to tens of thousands of potentially affected veterans in Arizona alone.

Beyond the military community, the Phoenix metro area and East Valley have significant first-responder populations — police, fire, and EMS professionals who experience occupational trauma exposure at elevated rates. A 2018 CAMH (Centre for Addiction and Mental Health) paper found that 29% of police officers surveyed from two Canadian police departments were in the diagnostic range for PTSD, suggesting substantial unmet need among civilian trauma populations as well.

Arizona Pain and Spine Institute’s locations in Mesa and Queen Creek provide accessible care for patients throughout the East Valley, including Gilbert, Chandler, Scottsdale, and Tempe. The practice’s FastTrack program also allows patients to receive expedited appointments without insurance delays — particularly relevant for patients in acute distress who cannot wait weeks for standard scheduling.

How to Determine If SGB for PTSD Is Right for You

Based on the clinical literature and Arizona Pain and Spine Institute’s published approach to patient care:

  1. Confirm Your Diagnosis: SGB for PTSD has been studied in patients with clinically diagnosed PTSD meeting DSM-5 criteria. Before pursuing SGB, ensure you have received a formal evaluation from a qualified mental health professional.
  2. Evaluate Your Current Treatment: The JAMA Psychiatry trial positioned SGB as an adjunct to standard care, not a standalone replacement. Consider SGB if you have been engaged in evidence-based treatment — such as cognitive processing therapy, prolonged exposure therapy, or SSRI medication — but have not achieved adequate symptom relief. Notably, the Lipov et al. 327-patient study found improvements “independent of concurrent psychotropic medication use.”
  3. Schedule a Consultation: Contact Arizona Pain and Spine Institute at (480) 986-7246 or visit gotpainarizona.com. The practice’s comprehensive initial evaluations assess your condition, medical history, and treatment goals. The FastTrack program is available for patients who need expedited scheduling.
  4. Discuss the Procedure and Expectations: During your consultation, Dr. Khan or Dr. Ryklin will explain the SGB procedure, discuss realistic expected outcomes based on current evidence, review potential side effects, and determine whether you are a candidate. Patients with certain conditions — such as bleeding disorders, recent neck surgery, or anticoagulant therapy — may not be appropriate candidates.
  5. Plan for Follow-Up: Consistent with the JAMA Psychiatry protocol, a treatment plan may include a second SGB injection approximately two weeks after the first. Post-procedure follow-up monitors symptom changes and guides decisions about additional treatment.

Conclusion

The 327-patient retrospective study by Lipov et al. — combined with the Level 1B randomized controlled trial published in JAMA Psychiatry, the 285-patient anxiety study, and the emerging six-month durability data — collectively represent the strongest evidence base yet assembled for stellate ganglion block as a PTSD treatment. For Arizona’s nearly 460,000 veterans, its first responders, and the broader civilian population affected by trauma, SGB represents a treatment option that works through a fundamentally different mechanism than traditional approaches: targeting the sympathetic nervous system directly rather than working through cognitive or pharmaceutical pathways alone.

Arizona Pain and Spine Institute offers SGB as part of a broader, individualized approach to both pain and conditions like PTSD and anxiety. If you or someone you know is living with PTSD symptoms that have not responded adequately to current treatment, the next step is a conversation. Contact Arizona Pain and Spine Institute at (480) 986-7246 or schedule through gotpainarizona.com.

Frequently Asked Questions

1. How quickly does a stellate ganglion block work for PTSD?

The JAMA Psychiatry 2020 trial observed measurable PTSD symptom reduction within two weeks of the first injection. The Lipov et al. 327-patient study measured improvements between 7 and 30 days post-procedure, with average PCL decreases of 28.59–29.2 points.

2. Is the stellate ganglion block FDA-approved for PTSD?

The SGB procedure and the anesthetics used (ropivacaine, bupivacaine) are FDA-approved for regional anesthesia. The application for PTSD is “off-label” — legal and supported by peer-reviewed research including a Level 1B RCT — but not yet specifically FDA-indicated for PTSD.

3. Does insurance cover SGB for PTSD at Arizona Pain and Spine Institute?

Coverage varies by plan and diagnosis. Arizona Pain and Spine Institute offers the FastTrack cash-pay program for patients who want expedited access without insurance delays. Contact the practice at (480) 986-7246 for specific coverage questions.

4. How many SGB treatments are typically needed for PTSD?

The JAMA Psychiatry trial used two injections spaced two weeks apart. The Lipov et al. study used a dual-level approach (injections at C6 and C3 levels). Dr. Khan and Dr. Ryklin develop individualized plans based on each patient’s response and the latest evidence.

5. Can I continue my current PTSD medications while receiving SGB?

Yes. The Lipov et al. 327-patient study specifically found statistically significant improvements “independent of concurrent psychotropic medication use.” SGB is designed as an adjunct, not a replacement, for existing care.

Disclaimer: This article references publicly available information from Arizona Pain and Spine Institute (gotpainarizona.com), JAMA Psychiatry (Rae Olmsted et al., 2020), Pain Physician (Lipov et al., January 2022), Military Medicine (Mulvaney et al., 2022), Clinical and Translational Neuroscience (Mulvaney and Rae Olmsted, February 2025), Cureus (Kirkpatrick et al., 2023), the U.S. Department of Veterans Affairs National Center for PTSD, the U.S. Census Bureau 2024 American Community Survey, the Arizona Department of Veterans’ Services 2024 Benefits Guide, and the Centre for Addiction and Mental Health (CAMH, 2018), including official documentation, government publications, and published clinical studies dated 2020–2025. All metrics and study findings are from documented, peer-reviewed sources. Results described are specific to the study populations and clinical settings mentioned and may vary based on individual patient circumstances, diagnosis severity, and treatment adherence. The stellate ganglion block for PTSD is an emerging application supported by clinical research but is not yet a first-line guideline recommendation. Approximately 19% of patients in the largest retrospective study did not achieve a clinically meaningful response. For current information about treatments offered at Arizona Pain and Spine Institute, consult gotpainarizona.com or call (480) 986-7246.