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How the Stellate Ganglion Block (SGB) Can Augment Treatment Plans

How the Stellate Ganglion Block (SGB) Can Augment Treatment Plans
By stella
13th Feb 2022

The following article refers to PTSD (Post-Traumatic Stress Disorder), whereas at Stella, we use the term PTSI (Post-Traumatic Stress Injury). We encourage you to adopt this language to break the stigma against Post-Traumatic Stress.  Read more about the shift from PTSD to PSTI here.

While sixty percent of men and fifty percent of women experience a trauma at least once in their lives the impact of trauma can vary greatly from person to person.1 That means that each healing journey is unique.

When we’re seeking relief from symptoms following trauma, many options come up: pharmaceutical drugs, exposure therapy, EMDR, insight-oriented therapy, RTM, yoga, mindfulness-based stress reduction… The list goes on.

For many, the formula for lasting relief combines biological and psychological interventions. Think ketamine infusion therapy plus group therapy or EMDR therapy plus daily meditation. 

The idea of researching all available treatments can be daunting. And deciding where to start our healing journey – or what to add to it – takes time and serious consideration. That’s where Stella comes in. 

In this article, we explain what the Stellate Ganglion Block by Stella is and how it can treat symptoms of PTSD (which Stella refers to as PTSI). We’ll also describe how we create a custom plan for each person we work with – because we don’t believe in a one-size-fits-all approach.

What Is The Stellate Ganglion Block?  

When we experience trauma, our body’s fight-or-flight response turns on and sometimes it stays on long after the traumatic event. Brain imagery data suggests that trauma symptoms cause changes that are visible in the brain.1 Dr. Eugene Lipov, Stella’s Chief Medical Officer, not only published the first case report exploring the use of SGB to proactively address trauma symptoms, but also published the first unified theory of how SGB works.

Dr. Lipov suggests that the local anesthetic temporarily “turns off” the Stellate Ganglion, which has been sending signals via nerve pathways to the amygdala, causing nerve growth.2 

The Stellate Ganglion Block (SGB) is an injection of local anesthetic into the stellate ganglion – a bundle of nerves in the neck – that helps restore normal biological function and can efficiently relieve even the most severe trauma symptoms. This can stop the nerve growth that is occurring as well as eliminate or prune the extra nerve fibers that have been created, thereby resetting the amygdala to its pre-trauma state.2 

Stella continually refers to emerging research and practice standards and is committed to using the most innovative methods available across our nationwide network of care. Instead of using the standard SGB protocol, which was developed for pain, we provide a “Dual Sympathetic Reset” to give those we work with the best chance of achieving a positive outcome.

The Benefits of SGB by Stella

We do not require trauma histories.

Before procedures, our Patient Care Team simply needs to know what symptoms are being experienced. They collect this information with a short, online test called the PTSD Checklist (PCL). Next, the score is reviewed and additional background information is collected. We’ll then discuss symptoms in further detail to help determine whether SGB is the right treatment path.

Most are surprised to learn that SGB is an effective treatment option regardless of gender, trauma type, age, PTSD-related medication use, or history of suicide attempts.4 

SGB can accelerate the positive impact of existing treatments.    

Feel like we’ve hit a plateau or are too overwhelmed by trauma symptoms to attend therapy is common – and SGB may be able to help. After SGB, a sense of calm may be felt which allows for a new type of participation in therapy that may have felt impossible before.

SGB can be done at any point on a healing journey. 

Whether trauma was experienced months or decades ago, SGB may be a good treatment option.

SGB takes less than 20 minutes. 

The injection itself takes less than 20 minutes. On the day of the procedure, expect to spend several hours at the Treatment Center to allow time for check-in, Twilight Sedation (if desired), the SGB, and follow-up observation.

SGB is safe.

Who performs the Stellate Ganglion Block? Every Stella doctor is Board-Certified and is personally trained by Stella’s Chief Medical Officer Dr. Lipov in our proprietary SGB methodology. We also require our doctors to use image guidance for correct needle placement. 

Interested in learning what medication is used in a Stellate Ganglion Block? The local anesthetics Stella uses are Bupivacaine or Ropivacaine, both of which are FDA-approved.

Serious side effects are extremely rare.

Stella’s Clinical Approach

Stella takes a trauma-informed approach to treatment and communication. We recognize that we all experiences and processes trauma differently. Our Patient Care Team will meet you exactly where you are. We’ll provide all information needed to confidently make decisions about treatment. 

We respect the relationships had with mental health care providers, doctors, or other healers because they share the same goal as Stella: to help those experience symptoms find lasting relief. We’re committed to building a world where no one needlessly suffers from the symptoms of trauma. Pairing our breakthrough Stellate Ganglion Block procedure with treatments from other skilled providers gets us one step closer. 

PTSD Medications & SGB

Before scheduling the Stellate Ganglion Block (SGB) treatment, a dedicated Patient Care Coordinator will review any medications actively being taking. Most prescription medications that treat symptoms of trauma do not interact with either of the local anesthetics – Bupivacaine or Ropivacaine – that Stella doctors use for SGB. 

After SGB, working with prescribing providers is recommended. They may decrease some medications or suggest taper off them altogether because the trauma symptoms are not as severe as they were before SGB. Others wish to stay on their medications. In all cases, we strongly encourage those who receive SGB to continue working with their prescribing providers to make the best decisions for their wellbeing.

Like many other medical procedures and surgeries, Stella requires that blood thinners are stopped in the days before the SGB procedure as they can cause problems. 

SGB & Other Therapies

The Stellate Ganglion Block (SGB) is just one part of the healing journey. For when we feel out of control in our bodies or alone in a room full of people, SGB has the potential to restore a sense of calm and clarity we crave. And when paired with skilled therapy, SGB can be life-changing. Again, the best outcomes are often the result of combining biological and psychological interventions. 

Mental healthcare providers can help maximize and maintain SGB’s positive impacts. For example, when we aren’t distracted by our symptoms, it becomes easier to be fully present during therapy sessions and thus integrate takeaways into everyday life. 

We think that those who received SGB by Stella put it best:

“I’m not as fearful or panicked as I was, but I’m still working through my anxiety with my therapist. She has hope for me and feels like I have made a good leap in my process.” 

“I feel like [SGB] has been a HUGE turning point in my healing. It’s allowed me to start a spiritual 12-step program that requires intense vulnerability in a group setting. I can feel appropriate emotions but not get triggered by others’ trauma. This is a first.” 

If you’re a mental health care provider who is looking to join Stella’s mission to end the needless suffering caused by emotional trauma, please find more information about how to collaborate with Stella here

How To Learn More

Tune in to our monthly webinar Treating Trauma: The Stella Approach hosted by Stella co-founder and leading trauma expert Dr. Shauna Springer and Stella Patient Ambassador Paul Whitmer. This webinar deep dives into how the Stellate Ganglion Block (SGB) addresses symptoms of emotional trauma.

You can also find more information on the “How SGB Works” page of our website. And if you’re looking for SGB treatments for PTSD (which Stella refers to as PTSI), explore Stella locations here.

  1. Alkire, M.T., Hollifield, M., Khoshsar, R., Nguyen, L., Alley, S. R., and Reist, C. (2015). Neuroimaging suggests that stellate ganglion block improves post-traumatic stress disorder (PTSD) through an amygdala mediated mechanism. Presented at the Anesthesiology Annual Meeting, October 24, 2015.
  2. Eugene G.LipovaJaydeep R.JoshiaSarahSandersaKonstantin V.Slavinb A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD) https://www.sciencedirect.com/science/article/abs/pii/S0306987709000413
  3. U.S. Department of Veterans Affairs. (2018, September 13). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. Retrieved February 2, 2022, from https://www.ptsd.va.gov/understand/common/common_adults.asp 
  4. Lipov, E. G., Jacobs, R., Springer, S., Candido, K. D., & Knezevic, N. N. (2022). Utility of Cervical Sympathetic Block in Treating Post-Traumatic Stress Disorder in Multiple Cohorts: A Retrospective Analysis. Pain Physician, 25(1), 77-85. Available from: https://www.painphysicianjournal.com/current/pdf?article=NzM5Nw%3D%3D 
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3 Advantages of SGB and Ketamine Infusion Therapy

3 Advantages of SGB and Ketamine Infusion Therapy
By stella
13th Feb 2022

The following article refers to PTSD (Post-Traumatic Stress Disorder), whereas at Stella, we use the term PTSI (Post-Traumatic Stress Injury). We encourage you to adopt this language to break the stigma against Post-Traumatic Stress.  Read more about the shift from PTSD to PSTI here.

At Stella, we continue to innovate in trauma treatments like our lives depend on it – because they do.

Before the COVID-19 pandemic, it was estimated that 6% of the U.S. adult population would struggle with symptoms following trauma exposure at some point in their lives, with 15 million suffering from trauma symptoms each year.1 At Stella, we believe the additional burden of psychological trauma beginning in 2020 is hard to calculate. 

In addition to this unprecedented health crisis, other factors –  a fight against systemic racism, intense political division, growing concerns about climate change, and economic uncertainty – created additional traumas and highly stressful experiences, which we know can cause PTSD (which Stella refers to as PTSI), anxiety, and depression.

Those seeking relief from trauma symptoms, anxiety, and depression deserve cutting-edge care. We believe in treatment plans that are practical, informed by modern neuroscience, and most of all, effective.

To help the people we treat achieve the best possible outcomes, we listen to each individual’s needs and collaborate with their support system of skilled mental health care providers, attentive doctors, empathetic healers, and compassionate family and friends. 

Treatment by Stella is just one aspect of the healing journey. We believe that when our biological interventions – like the Stellate Ganglion Block (SGB) and/or ketamine infusion therapy – are paired with psychological interventions, the result can be life-changing. This is the new model of trauma treatment. And it’s what people in need of relief deserve. 

Stella is ushering in breakthrough treatments for trauma symptoms, anxiety, and depression. Our treatments are fast, effective, and research-backed. If you’re considering SGB or ketamine infusion therapy by Stella, here are some advantages.

1. Breaking Down The Barriers To Seek Treatment

One of the primary barriers to seeking trauma treatment is overcoming the stigma associated with it. Stigma is often used in mental health conversations therefore,  we feel it is important to define it for the purposes of this article.

stigma | ˈstiɡmə

a mark of disgrace associated with a particular circumstance, quality, or person

Shame, disgrace, and dishonor also capture the idea of the stigma around mental health. 

The truth is that it’s ok to need help and to ask for it. This is why Stella exists. We’re relentlessly committed to the care of those experiencing trauma symptoms. We’ll listen to you so we can understand what you’re going through and learn how we may be able to help. We’ll never judge or make assumptions about you or your experiences.

So why is there a stigma associated with trauma, anxiety, and depression? Historically, experiencing these conditions – let alone seeking relief from them – was considered taboo. For this reason, we may have avoided or waited to seek treatment because we were worried about being treated differently or unfairly. 

Stigma is driven by a lack of information, myths, and fear. Misrepresentations of people diagnosed with trauma symptoms, anxiety, and depression add fuel to the fire. 

In addition to stigma, we may avoid seeking treatment because we think that it requires us to relive their trauma. At Stella, we’ll never ask about personal trauma histories. 

To determine who may be a good candidate for treatment, we simply need to know which symptoms are being experienced to understand the severity and we’ll complete a health review. We can collect this information through online forms or over the phone. This helps us confirm that SGB and/or ketamine infusion therapy is right for each unique individual.

2. SGB and Ketamine Infusion Therapy by Stella Are Effective 

Advances in neurobiological models of PTSD (which Stella refers to as PTSI) allow Stella to deploy effective treatments. We know that the greatest possible relief occurs when biological and psychological treatments are used together strategically. 

The American Journal of Psychology called ketamine infusion therapy “one of the most important breakthroughs in antidepressant treatment in decades.”2 Ketamine infusion therapy caused a paradigm shift in the treatment of major depressive disorder and treatment-resistant depression because it can decrease symptoms within hours instead of weeks or months. This finding is incredibly encouraging because when we’re struggling with depression, we might not be able to wait for relief. 

Research about SGB is equally compelling. Studies consistently indicate that it can reduce symptoms following trauma by 50% and that it’s particularly helpful in improving symptoms of irritability, surges of anger, difficulty concentrating, and trouble falling or staying asleep.3

When we are no longer overwhelmed by symptoms, we are much more willing and able to incorporate new learnings from therapy into our daily lives. We may also be able to discuss topics that before would have been too overwhelming. 

More than 83% of people who receive SGB by Stella experience relief from symptoms of trauma.4

3. Stella Customizes Your Treatment Plan

Stella will meet your needs before, during, and after treatment. 

Before Treatment

Our Patient Care Team will review symptoms and medical history to determine who is a good candidate for treatment. From there, we will customize a treatment plan. Depending on the symptoms, they may recommend SGB, ketamine infusion therapy, or both. 

On Treatment Day

Stella is committed to the principle of trauma-informed care with the goal of making the people in our care feel safe. We take common triggers and preferences into account so others don’t have to. 

After Treatment 

Stella provides the people we work with concierge-level access to a network of mental healthcare professionals which allows for further healing after SGB and/or ketamine infusion therapy. 

Our Patient Care Team will check in to measure symptoms and ensure we are providing proper follow care and resource.

After being treated by Stella, some may decide to schedule a follow-up SGB or additional ketamine infusion therapy sessions. Our Patient Care Team will thoroughly explain all options so an informed decision can be made. 

More on Ketamine Infusion Therapy by Stella 

Ketamine infusion therapy by Stella is administered by trained personnel under the direction of a Stella Board Certified Doctor who carefully monitors dosing and makes real-time adjustments as needed. Unlike other ketamine providers, we do not ask those in our care to participate in talk therapy during the infusion session. 

Most of the treatment locations allow people to bring their own music and a family member or friend. This allows them to set the tone of their infusion session. 

More on SGB by Stella 

In our article How the Stellate Ganglion Block (SGB) Can Augment Treatment Plans we explain what SGB is, highlight its benefits, and discuss how it works in combination with therapy and/or medications. 

Ready To Kickstart Lasting Relief? 

A consultation could change everything. Contact our Patient Care Team directly by calling 1-866-497-9248 or emailing care@stellacenter.com

  1. U.S. Department of Veterans Affairs. (2018, September 13). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. Retrieved February 2, 2022, from https://www.ptsd.va.gov/understand/common/common_adults.asp 
  2. Newport, D. J., Carpenter, L. L., McDonald, W. M., Potash, J. B., Tohen, M., Nemeroff, C. B., & APA Council of Research Task Force on Novel Biomarkers and Treatments. (2015). Ketamine and other NMDA antagonists: early clinical trials and possible mechanisms in depression. American Journal of Psychiatry, 172(10), 950-966. Available from: https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2015.15040465#B1 
  3. James H. Lynch. Stellate ganglion block treats posttraumatic stress: An example of precision mental health. 28 August 2020. From https://onlinelibrary.wiley.com/doi/10.1002/brb3.1807
  4. Lipov, E., Ritchie, E.C. A Review of the Use of Stellate Ganglion Block in the Treatment of PTSD. Curr Psychiatry Rep 17, 63 (2015). https://doi.org/10.1007/s11920-015-0599-4. Available from: https://link.springer.com/article/10.1007/s11920-015-0599-4; Navaie, M., Keefe, M.S., Hickey, A.H., Mclay, R.N., Ritchie, E.C., & Abdi, S. (2014). Use of stellate ganglion block for refractory post-traumatic stress disorder: A review of published cases. Journal of Anesthesia and Clinical Research, 5(4), [1000403]. https://doi.org/10.4172/2155-6148.1000403
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A New Model For Care

A New Model For Care
By stella
13th Feb 2022

The following article refers to PTSD (Post-Traumatic Stress Disorder), whereas at Stella, we use the term PTSI (Post-Traumatic Stress Injury). We encourage you to adopt this language to break the stigma against Post-Traumatic Stress.  Read more about the shift from PTSD to PSTI here.

Connect Trauma Survivors With the Most Innovative and Effective Treatments

Are you searching for relief from symptoms of PTSD and feeling stuck? You’re not alone. While PTSD has been referred to as a disorder, many claim it’s an injury. Stella and others have suggested a new term – Post Traumatic Stress Injury (PSTI) – in place of Post Traumatic Stress Disorder (PTSD)1.

The traditional approach to treatment for people who have experienced trauma is a combination of trauma-focused psychotherapy and symptom-focused medications. While this is effective for some, it does not work for everyone. The good news is that there are additional options.

This article explores what it’s like to pursue traditional options compared to how Stella connects those experiencing trauma symptoms with the most innovative and effective treatments. 

Life After Trauma

Did you know that sixty percent of men and fifty percent of women experience trauma at least once in their lives?2 Some experience a trauma once, and others experience multiple traumas over the course of a lifetime. From natural disasters to sports injury to combat to childhood abuse, there are many different types of trauma.  

In fact, research suggests that only 2-11% of those experiencing trauma symptoms are actually diagnosed.3 And no two experiences are exactly the same. When we experience symptoms of trauma, we can feel agitated, depressed, dizzy, confused, and more. These symptoms can be overwhelming and get in the way of everyday life. 

Overcoming Barriers to Treatment 

Once we’re diagnosed with trauma symptoms and seeking treatment, we must overcome the stigma associated with mental health, research treatment options, and find a trustworthy provider. This process can be challenging. For many, it’s emotional, time-consuming, and exhausting. 

Many treatment options require a formal diagnosis. To receive one, we must speak to a mental health professional about our trauma history and the symptoms we are experiencing. Sharing this information with a stranger can be incredibly difficult. 

Traditional PTSD Treatments 

Talk Therapy

Talk therapy requires us to continuously confront our trauma. For many, this is asking too much. 

Medication

Medications can reduce symptoms following trauma exposure. But some of us are not willing to take medications due to their high cost, side effects, or risk of dependency. 

The Need To Innovate on Traditional Treatments

We may not experience relief immediately after we start talk therapy and/or taking medication. The time it takes to experience relief after beginning a new treatment plan varies from person to person. But what is true for all of us is that working toward a meaningful improvement requires commitment, patience, and self-compassion. 

While there are many medications that can effectively treat symptoms following trauma exposure, around 20-30% of people who start taking medication stop.4 

20-25% of people diagnosed with trauma symptoms self-medicate with alcohol and drugs.5

There are many talk therapies developed specifically for trauma, including Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Stress Inoculation Training, Stellate Ganglion Block (SGB), and ketamine infusion therapy. In addition, the past decade has seen the growth of new biological treatment options like Stellate Ganglion Block (SGB), and ketamine infusion therapy.

A New Model of Care

At Stella, we continue to innovate like our lives depend on it – because they do.

We’re built on an entirely new understanding of trauma treatment. Stella believes in the fusion of biological, psychological, and mind-body practices. 

Stella simplifies the healing journey. Our Patient Care Team will review symptoms and medical histories to determine if the Stellate Ganglion Block (SGB) or ketamine infusion therapy – two cutting-edge treatments that are fast, effective, and research-backed – is the right treatment plan.

You are our priority before, during, and after your treatment. Our Patient Care Team will periodically follow up with you to track your progress and ensure that you have the resources you need. We can also assist you in finding a Stella preferred mental healthcare provider in your area.

Stella is a team of medical doctors, psychologists, Patient Care Coordinators, and tireless advocates who are committed to your healing. If you’d like to learn more about SGB and ketamine infusion therapy, contact our Patient Care Team directly by calling 1-866-497-9248 or emailing care@stellacenter.com. 

  1. Itkowitz, C. (2021, October 28). Dropping the ‘D’ in PTSD is becoming the norm in Washington. The Washington Post. Retrieved February 2, 2022, from https://www.washingtonpost.com/news/powerpost/wp/2015/06/30/dropping-the-d-in-ptsd-is-becoming-the-norm/
  2. U.S. Department of Veterans Affairs. (2018, September 13). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. Retrieved February 2, 2022, from https://www.ptsd.va.gov/understand/common/common_adults.asp 
  3. Ellen C. Meltzer, MD MSc,1 Tali Averbuch, MPP,1 Jeffrey H. Samet, MD MA MPH,1,5 Richard Saitz, MD MPH,1,3,4 Khelda Jabbar, MD,6 Christine Lloyd-Travaglini, MPH,7 and Jane M. Liebschutz, MD MPH1,5 Discrepancy in diagnosis and treatment of post-traumatic stress disorder (PTSD): Treatment for the wrong reason https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310322/Spoont, M, Arbisi, P., Fu, S., Greer, N., Kehle-Forbes, S., Meis, L., Rutks, R., & Wilt, T.J. (2013). Screening for Post-Traumatic Stress Disorder (PTSD) in Primary Care: A Systematic Review [Internet]. Washington (DC): Department of Veterans Affairs (US). Available from: https://www.ncbi. nlm.nih.gov/books/NBK126691/ 
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7 Ways To Take Care of Yourself or Others Before and After SGB

7 Ways To Take Care of Yourself or Others Before and After SGB
By stella
13th Feb 2022

The following article refers to PTSD (Post-Traumatic Stress Disorder), whereas at Stella, we use the term PTSI (Post-Traumatic Stress Injury). We encourage you to adopt this language to break the stigma against Post-Traumatic Stress.  Read more about the shift from PTSD to PSTI here.

Are you in the process of scheduling your Stellate Ganglion Block (SGB) or do you already have a treatment time on the books? While SGB is only a 20-minute procedure, Stella is committed to you before, during, and after treatment.

Below are 7 ways to take care of yourself or someone you care about before and after SGB.  

#1: Make a Plan

Clear your schedule for the day of and day after your SGB. Plan to take off work and organize a support system to temporarily manage your responsibilities (child care, errands, household chores, etc.).

Pick a close family member or friend to accompany you to your SGB treatment. Think of them as your healing companion – someone who will support and care for you on the day of your SGB. 

If you plan on updating your close friends and family about your treatment, we suggest that you set communication expectations with them beforehand. Explain that you will share a quick update immediately after your SGB procedure followed by more details the next day. This can help you “unplug” and focus on resting.

#2: Sleep

Take a long nap after you leave the Stella treatment location. Sleep allows your body to heal and feel calm. Many patients find it helpful to turn off their cell phones while resting.

#3: Eat and Hydrate

Plan a good meal with your healing companion so you can have an enjoyable and stress-free experience.

Tips: 

  • Before you eat or drink, ensure that you can swallow normally. Nearly half of the people Stella treats experience hoarseness or trouble swallowing that resolves within 24 hours of the procedure.
  • Limit caffeine and alcohol.  In the 12-24 hours after your procedure, your body and brain will “re-establish” their connection. Psychoactive substances influence the sympathetic nervous system and can interfere with this process. 

#4: Listen to Your Body

Some people feel energized after SGB, and others feel tired. Both reactions are normal!

If the mood strikes, you can take a walk or do light exercise. However, you should wait 24 hours before doing intense exercise. You can resume normal activities two days after your treatment.

#5: Note Changes in Your Symptoms 

You may not feel a difference in your symptoms at first but those close to you might notice changes in your behavior. Ask a trusted family member or friend to take inventory of how you’ve changed and have them share their observations with you. You may need to encounter stressful situations before realizing that your response to them is different.

#6:  Create New, Healthy Habits

Make mindfulness, meditation, yoga, and/or regular exercise part of your daily life. These activities can keep your brain and body working in harmony. 

The desire to smoke, drink, and/or use other substances may change after SGB. Some people that Stella treats report decreased interest in or need to use substances. For many, this change can make it easier to examine substance use habits.

#7: Partner With a Mental Health Provider 

After SGB, people feel a new sense of calm that can accelerate the positive impact of existing therapies (e.g., talk therapy, EMDR, CBT, DBT, etc.). If you already have a mental healthcare provider, we suggest that you continue working with them to further your healing.

If you do not have a mental healthcare provider, Stella may be able to refer you to one. Contact your Patient Care Coordinator for more information.

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