Stellate Ganglion Block (SGB) to Help with Addiction: A Promising Approach

Addiction is a pervasive issue that affects millions of people worldwide, causing significant personal, social, and economic consequences. Traditional treatments for addiction, including medication-assisted treatment (MAT), counseling, and support groups, have varying levels of success. Recently, Stellate Ganglion Block (SGB), a procedure primarily used for pain management and treatment of PTSD, has emerged as a potential intervention for addiction. This blog explores what SGB is, how it works, and its potential role in treating addiction.

What is Stellate Ganglion Block (SGB)?

Stellate Ganglion Block is a medical procedure that involves injecting a local anesthetic into the stellate ganglion, a collection of nerves located in the neck (on both sides).  These nerves are part of the sympathetic nervous system and play a role in regulating the body’s fight-or-flight response. By blocking these nerves, SGB can help modulate the autonomic nervous system, which may have therapeutic benefits for various conditions, including chronic pain, PTSD, and now, potentially addiction.

Mechanism of Action

The stellate ganglion is part of the sympathetic nervous system, which influences stress responses, mood regulation, and various physiological processes. When the stellate ganglion is blocked, several changes occur that can be beneficial for individuals struggling with addiction:

1. Reduction of Sympathetic Nervous System Activity: By dampening the sympathetic nervous system, SGB can reduce the body’s stress response. Since stress is a significant trigger for substance use and relapse, this reduction can help individuals manage their cravings and decrease the likelihood of relapse.  This may also be quite helpful in patients experiencing withdrawal symptoms.
2. Improvement of Mood and Anxiety Symptoms: SGB has been shown to reduce symptoms of anxiety and depression by altering the levels of neurotransmitters and stress hormones. Many individuals with addiction also suffer from co-occurring mental health disorders, and alleviating these symptoms can support recovery efforts.
3. Neuroplasticity: SGB may promote neuroplasticity, the brain’s ability to reorganize and form new neural connections. This can be particularly beneficial for individuals recovering from addiction, as it supports the development of healthier behavioral patterns and coping mechanisms.
4. Pain Relief: Chronic pain is often a contributing factor to substance abuse. By providing effective pain relief, SGB can reduce the need for pain medications, including opioids, and support recovery from addiction.

The Procedure

The SGB procedure is safe when performed by an expert trained in ultrasound and board certified in Pain Medicine.  It is typically performed on an outpatient basis and involves the following steps:

1. Preparation: The patient is positioned, and the neck area is cleaned and sterilized. Imaging guidance, ideally ultrasound, is used to locate the stellate ganglion and more importantly, to avoid critical structures such as the carotid artery and internal jugular vein.  Unlike using fluoroscopy, ultrasound provides significant advantage in that it providers a real time dynamic image of anatomic structures as well as no radiation.
2. Injection: Local anesthetics are injected near the stellate ganglion using a fine needle. The procedure usually takes about 15-20 minutes, and the patient is monitored for a short period afterward.
3. Recovery: Most patients experience immediate relief of symptoms, although the effects may vary. Some may require multiple injections for sustained benefits.

Current Research on SGB for Addiction

Research on the use of SGB for addiction is still in its early stages, but preliminary studies and case reports suggest promising results:

1. Case Studies: Individual case reports have highlighted significant reductions in cravings and substance use following SGB treatment. These reports also note improvements in mood and anxiety symptoms.
2. Clinical Trials: Ongoing clinical trials are investigating the efficacy of SGB for various types of addiction, including opioid, alcohol, and stimulant use disorders. These studies aim to determine the optimal dosing, frequency, and duration of SGB treatment for addiction.
3. Comparative Studies: Some studies are comparing SGB with other treatment modalities to assess its relative efficacy and potential as an adjunctive therapy.

Benefits of SGB for Addiction

The potential benefits of SGB for addiction include:

1. Reduction of Cravings: By modulating the stress response and improving mood, SGB can help reduce cravings for addictive substances.
2. Rapid Onset: Unlike some treatments that take weeks to become effective, SGB can provide immediate relief of symptoms, making it particularly useful for individuals in acute distress.
3. Dual Action: SGB addresses both the physiological and psychological aspects of addiction, offering a comprehensive approach to treatment.
4. Improvement of Co-Occurring Conditions: Many individuals with addiction also suffer from chronic pain, PTSD, anxiety, or depression. SGB can alleviate these conditions, supporting overall recovery efforts.

Challenges and Considerations

Despite its potential, the use of SGB for addiction is not without challenges:

1. Safety and Side Effects: While SGB is generally considered safe, especially when performed by a board certified pain medicine specialist with years of experience in the use of ultrasound, potential side effects include temporary hoarseness, difficulty swallowing, and, in rare cases, more serious complications. Careful patient selection and monitoring are essential.  Horner’s Syndrome, which is characterized by a droopy eyelid (ptosis), small pupil (miosis), decrease sweating (anhidrosis) is a desired temporary side effect that ensures successful blockade of the fight or flight system/stellate ganglion.
2. Need for Further Research:  Despite some promising case reports, more extensive and rigorous research is needed to fully understand the long-term efficacy and safety of SGB for addiction, as well as to establish standardized treatment protocols.

Conclusion

Stellate Ganglion Block represents a novel and promising approach to treating addiction by targeting the sympathetic nervous system. Its ability to reduce cravings, alleviate co-occurring mental health conditions, and provide rapid relief makes it an attractive option for individuals struggling with addiction. However, further research is needed to fully validate its efficacy and safety.

As with any medical treatment, individuals considering SGB for addiction will consult with an expert at StrIVeMD Wellness and Ketamine to discuss their specific situation and determine the best course of action. With careful consideration and appropriate use, SGB has the potential to become a valuable tool in the fight against addiction, offering hope and healing to those in need.