Resetting the body's alarm wire: the Stellate Ganglion Block
Tales of "miraculous" and "prolonged" recovery with implications for the vagus nerve, gut health, and the brain
As I was walking past a clinic in Switzerland one day last year, I saw a sign advertising a nerve block that could help reduce stiffness and pain. I called them and we talked about the imbalance on either side of my body—stiffness on the right side and numbness on the left. They hypothesized that it was due to neuroinflammation (brain inflammation) and vagal nerve trauma and that I would be a good candidate for the procedure, but they quoted me some exorbitant cost that just wasn't in the cards then. When I got back to Canada last year I called the pain clinic in Manitoba and they put me on the waiting list for the procedure. Well, the call came in yesterday, nearly a year later, and I'm going to have the block done next week!
The stellate ganglion block is a simple surgery: an injection of bupivacaine into a bundle of nerves in your neck near a spinal juncture, which changes the vagus nerve’s behaviour. This nerve plays a vital role in the body's "rest and digest" response and communicates directly with the gut.
The nerve block could be indicated for people who have pain related to nervous system imbalances, including neuroinflammation, associated physiological and behavioural symptoms (including PTSD), nerve-related pain, and other neurological disorders.
it might reset a PTSD patient's overreaction to stimulus — their "fight or flight" response — by interrupting connections between the sympathetic nervous system and central nervous system.
In the review of the literature, it seems that an SGB could improve some of the following things1:
Improved brain blood flow: The injection relaxes blood vessels, letting blood flow more easily. This can be especially helpful in the head, neck, and upper body. Given the recent discovery that I have some kind of new vasoconstriction going on, a block might help open some things up.
Parasympathetic attenuation (fight-flight “off” switch): One of the problems related to vasoconstriction and neuroinflammation is a constant activation of the sympathetic nervous system. Many of the strategies I've already adopted have reduced this phenomenon quite dramatically, but every once in a while it's as if my body gets stuck in the wrong activated gear— I end up with paresthesia and exhaustion. I wonder if an SGB might eliminate this “stuckness” in that wrong gear.
Effects on eyesight: The injection might make blood move faster through the veins in my retina. It can also sometimes lower pressure inside the eye and boost oxygen levels around it. Could this (gasp, knock on wood) help with my eyesight? What a miracle that would be.
Immune and hormone boost: The injection has the potential to influence your immune system and hormone production. Scientists think it might affect the release of melatonin, which would improve the sleep cycle.
Pain signalling: SGB may attenuate pain signalling and correlated inflammatory processes, including depression, which has been referred to, at least in part, as a neuroinflammatory disorder.
Sympathetic overdrive—that sense of fight-flight-freeze—is often brought about not just because of a perception of unsafety, but the very neurochemical state of being ill. That state causes a vicious cycle of chronic stress, inflammation, and nervous system dysregulation: real physiological changes to the body. Sadly, for many people, the search for relief may lead to substance use, including alcohol, which provides temporary relief by binding to GABA receptors, but further taxing an already strained system in the long run, and impacting vital functions like memory and concentration.
Sources of systemic neuroinflammation
COVID-19 has also fostered chronic low-grade neuroinflammation in a huge percentage of the population, for many, unwittingly so. Some scientists argue that the illness and vaccination seem to result in injury to our hippocampus, veins, and heart; injury to the brain (possibly through lipid nanoparticles) leads to chronic neuroinflammation, which then compromises our behaviour. If the SGB has a positive impact on the brain by attenuating the afferent signals from the body (to the brain), then it might be a great hack for people who are experiencing… things they’ve never experienced before.
The opposite is also true—an SGB could attenuate the signals from the brain to the gut. A growing body of research also reveals a strong link between gut health and neuroinflammation. Leaky gut can allow inflammatory substances to enter the bloodstream and potentially reach the brain. Conditions like Irritable Bowel Syndrome (IBS) or Inflammatory Bowel Disease (IBD) demonstrate this, as they're linked to an increased risk of neurological disorders. Similarly, autism is highly correlated with certain kinds of gut dysbiosis and infections like c. difficile. Since the vagus nerve influences gut function and since gut health can impact the brain through neuroinflammation, it's theorized that SGB could have a positive, indirect effect on the gut-brain axis.2
PTSD, too, seems to correlate with particular gut profiles. While medication and therapy are cornerstone treatments for PTSD, their effectiveness is often limited, especially in cases that might involve substance use. This is because these treatments don't always directly target the underlying nervous system imbalances, including the connection to the gut. Some of the best SGB research, however, has been conducted to help combat veterans recover PTSD.3 The pioneer of the procedure, Chicago-based Dr. Eugene Lipov, has even gone so far as to re-label the disorder PTSI (Post-Traumatic Stress Injury), because he sees it as something temporary that can be improved. He even had the procedure done on himself. The observed improvements in PTSD symptoms for veterans include brain function, memory, nervous system (and emotional) regulation, and gut-related inflammation.
Of course, this is a bit of an experimental therapy since results can’t be guaranteed, and people will respond uniquely. But the SGB is a promising multifaceted approach since the injection changes the behaviour of the alarm messenger wiring between the gut and the brain.
Update following treatment on left side
When I arrived at the hospital in the morning, they mixed everything up from my name to the kind of treatment I was going to get, so I guess it's a good thing I'm unreasonably okay shape and can advocate for myself.
That nonsense notwithstanding, the procedure went really well. It took about 30 minutes. You get up on a table, they clean you up with surgical soap, and then they start poking around your vertebrae with an ultrasound machine. Once they find the right spot, they poke around with a long needle, and then make the injection once they find the sweet spot.
I had the left side done, because that's commonly the side they start with, and when I asked if I could get the right side done sometime soon, they said it was likely and that they'd follow up with me early next week.
The relief was immediate. I experienced increased bloodflow on the left side and a profound sense of calm. Of course, for the first couple hours I also felt a little bit like I was on heavy drugs (because I guess I was!) – I was very sluggish and my left eye became bloodshot and droopy. I was able to sleep during the day, and even performed a concert in the evening. The following morning, I woke up more rested than I have experienced in years, the tinnitus was much lower on that side of my body, and for the most part that feeling of calm remains. I'm very intrigued about getting that other side done.
https://www.sciencedirect.com/topics/medicine-and-dentistry/stellate-ganglion-block#:~:text=Absolute%20contraindications%20of%20SGB%20are,ipsilateral%20side%3B%20and%20(3)
https://www.ncbi.nlm.nih.gov/books/NBK442253/
https://academic.oup.com/milmed/article/178/2/e260/4210889