Stellate Ganglion Block in the Treatment of Pain: An Overview

Stellate Ganglion Block in the Treatment of Pain - PMIR Medical Center

Nerve blocks are utilized to treat chronic pain and other health conditions wherein a damaged, or disordered nerve must be temporarily blocked to reduce or even stop the pain and address other symptoms. Nerve blocks involve injecting an anesthetic or steroid around the nerve, disrupting the transmission of signals through the nerve. A well-known example of a nerve block is an epidural nerve block, which eliminates pain from the belly button down and still feels pressure in the area.

In most cases, nerve blocks involve imaging techniques to help guide the needle and target the right area. The stellate ganglion block is an example of a nerve block utilized often in treating chronic pain when other less invasive therapies (such as physical therapy and pharmacology) did not effectively reduce symptoms. Nevertheless, like other nerve blocks, a stellate ganglion block is minimally invasive. This block is also used in the treatment of many other conditions.

Stellate Ganglion Anatomy

The stellate ganglion is a cluster of nerves near the voice box and neck portions of the spine (cervical spine), and it connects to many nerves in the upper body. It is a good target for a nerve block in treating sympathetically mediated pain in the upper body because the nerves that run through the ganglion connect with the sympathetic nervous system of the head, heart, arms, and neck.

As such, a stellate ganglion block is an example of a sympathetic block. Our nervous system relies on our nerves’ complex interconnectivity to transmit signals from and to the brain. A ganglion serves as a sort of complicated intersection where a block might have the most far-reaching effect. To that end, there are risks and considerations for a stellate ganglion block and contraindications (factors and conditions that rule out the use of the block).

What Conditions Does a Stellate Ganglion Block Alleviate?

Stellate ganglion blocks can be used therapeutically or as a diagnostic tool (to rule out potential causes of pain). As a sympathetic block connected to multiple upper body areas, it may be part of multiple treatment plans. Common conditions that may call for a stellate ganglion block include:

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) of the head and arms are characterized by ongoing and prolonged pain after an injury. CRPS includes feelings of pain and discomfort at physical contact (also known as allodynia), swelling and changes in the area in terms of color and temperature, abnormal pain levels, and ranges from mild increases in susceptibility to pain in an area to debilitating and disabling pain. It can be both acute and chronic.

CRPS is usually associated with post-injury inflammation, triggered during the healing process. A stellate ganglion block may alleviate symptoms by improving blood flow by blocking the sympathetic nerves. However, it should be noted that these blocks are not used as often as before to treat CRPS. Other injections, such as corticosteroid injections against inflammation and Botox injections to relieve cramped muscles, maybe part of the treatment plan.

Peripheral Vascular Disease

Peripheral vascular disease occurs most often in the legs but can occur in the upper body. It is defined by narrowing and deteriorating blood vessels outside of the heart, leading to major circulatory problems, most significantly a lack of healthy blood flow to limbs and organs. Peripheral vascular disease is most often caused by a buildup of plaque in the artery walls (also known as atherosclerosis).

It is common among people with coronary artery disease. This can lead to limb ischemia or massively reduced blood flow due to arterial obstruction, a painful and dangerous condition. A sympathetic block can alleviate peripheral vascular disease’s pain symptoms and provide much-needed relief throughout the treatment process.

Postherpetic Neuralgia

Some viral infections, including infection with shingles, can cause nerve damage and associated pain. This is called postherpetic neuralgia. Shingles is a condition caused by a repeat infection with herpes zoster (chickenpox). A sympathetic block in the form of a stellate ganglion block can help combat pain symptoms in damaged nerves by shutting down intercepted pain signals as they are transmitted to the brain.

Post-Traumatic Stress Disorder (PTSD)

A stellate ganglion block has shown promising results, even in randomized trials, as part of a treatment plan for post-traumatic stress disorder (PTSD). PTSD symptoms include physical reactions and changes in the sympathetic nervous system because of trauma. Stellate ganglion blocks have been researched as a potential treatment tool for PTSD since 1990 due to their use in sympathetically mediated pain. Since then, different studies have produced favorable results in reducing symptoms of anxiety and stress in PTSD.

Other Pain Disorders

A stellate ganglion block can also be used in the diagnosis or treatment of:

  • Chronic pain
  • Hyperhidrosis
  • Raynaud disease
  • Cluster headache
  • Intractable angina
  • Meniere syndrome
  • Vascular headache
  • Upper extremity embolism
  • Orofacial pain (trigeminal pain)

There are various contraindications for a stellate ganglion block, including recent heart attacks, glaucoma, and severe emphysema. Be sure to discuss your medical history thoroughly with a pain specialist before considering a sympathetic block or any nerve block.

How Is a Stellate Ganglion Block Performed?

A stellate ganglion block is performed in a simple multistep process utilizing fluoroscopy, a local anesthetic, and a quick injection. The injection itself will be little more than a pinch because of the anesthetic. Still, to properly locate the ganglion, a physician would have to apply some pressure on the neck, which can be uncomfortable for a few seconds.

How Often Is a Stellate Ganglion Block Required?

The number of injections depends on the condition being treated and the injection’s purpose (diagnostic or treatment). Multiple injections are usually scheduled for pain relief. There are a few potential side effects to the injection, especially immediately following the injection. They can include drooping eyelids, heavy or warm sensations in the arms, and a stuffy nose. These post-injection symptoms usually pass within the day. The onset of relief can range from immediate to within a few days, depending on the patient and the condition.

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