The two leading forms of chronic pain in America are back and neck pain, with neck pain often accompanying tight shoulders, headaches, migraines, lack of sleep, and other forms of pain, both annoying and some debilitating. Chronic pain in general is a problem not just among Americans but throughout the world, especially in developed countries where more data on the issue is available.
As medicine moved to improve and solve some of our greatest troubles, including bacterial infection and the fight against dangerous viruses, we also began to approach a topic that had largely been addressed at each doctor’s own discretion: the topic of pain and its relationship to both mental and physical health. Pain is more than just the perception of an individual’s suffering, or a warning sign of dangerous things – sometimes it develops for no good reason, existing for its own sake, or as a result of the inevitable aging process.
Chronic pain especially is a serious issue, causing early retirement and tanking a patient’s quality of life as they age. Early attempts to standardize pain management eventually led to the modern-day holistic, multimodal approach, in which specialists take on several different tools and techniques to tackle each individual’s own pains and challenges, sometimes through pharmacology, sometimes through physical or mental therapy, and sometimes through medical – and surgical – intervention. Especially for pain in the neck, one form of treatment is the use of stellate ganglion blocks to slowly help a patient manage their chronic neck pain and eliminate or suppress the symptoms that keep them from living a normal life.
What Is the Stellate Ganglion?
Located in the neck near your voice box (larynx), the stellate ganglion is formed between the fusion of a cervical and thoracic ganglion, and it is one among a long series of sympathetic ganglia formed on the spinal cord, responsible for sympathetic nervous system’s communication between the brain and the body, triggering fight-or-flight responses and informing the body of stress and potential danger.
The stellate ganglion in particular is linked to extreme palm sweating, and a rare blood condition in the fingers (wherein circulation is slowed or cutoff, creating pale or bluish digits). Stellate ganglion blocks have been proven to be particularly effective in addressing complex regional pain syndrome (extreme, varying pain in one or more limbs), as well as chronic neck pain.
The point of a stellate ganglion block is to treat and manage chronic pain, as well as:
- Herpes zoster infection (shingles) on the neck, head, upper chest and arm
- Phantom pain
- Reflex sympathetic dystrophy
- Sympathetic maintained pain
- Complex regional pain syndrome
How Are Stellate Ganglion Blocks Performed?
The procedure itself is quite simple, sometimes done using only injected local anesthesia, and sometimes done under sedation. You may be given relaxants intravenously to keep you calm. Then, an x-ray and thermostat are used to locate the ganglion, and a cleansing solution will be applied to the skin on your neck before the procedure begins. Then, a very thin needle is passed through the skin to the area near the ganglion, injecting a local anesthetic. Finally, using some form of guidance (ultrasonic or x-ray), a different needle is injected into the ganglion. The doctor will then inject a small amount of anesthetic medication.
After a few minutes of sitting or laying still, the doctor will give you the green light, and you’re free to leave. Sometimes, the doctor may instead choose to put you under or use medication that’s likely to give you a brief period of amnesia for the duration of the injection. It’s generally safer to avoid putting someone under if it isn’t necessary, so most doctors opt for local anesthesia and intravenous medication for relaxation purposes. And that’s that. It’s quite simple, requires no expensive or risky step-by-step surgical procedure, and only involves a very small and quick injection into a bundle of nerves in the neck.
After the Procedure
The procedure is entirely unobtrusive, even in the greater scheme of things. This means that you’re free to get back to work after 24 hours, and you can generally do most things even immediately after the procedure as long as they do not require driving or strenuous, rigorous physical effort.
The most common side-effects of the procedure are a hoarse voice, so don’t strain your vocal chords and take it easy on any speaking roles in the next day or so. Be sure to stay hydrated and keep your voice strain at a minimum. Aside from a temporarily coarse voice, there are a few other possible side effects.
Considering the Risks
The sympathetic nervous system is responsible for a very large array of involuntary actions and responses in the body, and injecting your stellate ganglion with anesthesia may cause a number of potential reactions, including:
- Tingling sensation in the arm/hand
- Involuntary teardrops
- Drooping eyelids/bloodshot eyes
- Nasal congestion/runny nose
- Lump in throat/difficulty swallowing
These symptoms are all temporary and usually subside within a few hours after the procedure has ended. A stellate ganglion block does not have lasting side effects.
Effectiveness of Stellate Ganglion Block Injections
The point of the block is to treat the symptoms and syndromes mentioned above, by injecting an anesthetic into the ganglion. While it’s normal and even expected to feel relief after the first injection, it usually takes more than one application of the block to completely combat the symptoms you’re experiencing.
Thorough follow-up is necessary to determine how many stellate ganglion blocks are needed for the procedure to achieve its desired effect. The first blockade is meant to relieve symptoms for several hours, with each successive injection increasing the duration more and more. For some people, symptoms subside after just a few injections, even less than five, while others might need as many as a dozen sessions, or more. This depends on a number of things, including the symptoms being treated, the level of pain the patient is experiencing, and the patient’s initial reaction to the treatment.
Because the stellate ganglion is responsible for a number of involuntary functions throughout the neck, chest, head and arm region, a stellate ganglion block can help return the body’s function to normal if a patient is experiencing a unique set of symptoms suggesting malfunction of the sympathetic nervous system. Depending on the origin of the pain, the block may not help. In that case, it’s likely your doctor will recommend a different treatment, or do more testing.