Home Medicine Letter to the Editor For: “Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series”
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Letter to the Editor For: “Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series”

  • Eugene Lipov ORCID logo EMAIL logo and Kevin Marmo
Published/Copyright: April 1, 2025
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 25 Issue 1

Dr. Niraj and colleagues reported the successful use of stellate ganglion block (SGB) as a treatment for mental health disorders (MHDs) that do not respond to standard management, known as treatment-resistant MHDs (tr-MHDs) [1]. This group of patients has limited options for managing their conditions. Autonomic dysfunction has been noted in the neurobiology of MHDs, including anxiety, depression, obsessive-compulsive disorder (OCD), panic disorder, and bipolar disorder (BD) [1]. SGB is an emerging treatment that reduces sympathetic activity and has shown benefits in managing post-traumatic stress disorder (PTSD).

In this report, four patients with diverse, tr-MHDs who received SGB were presented. The treatment led to improvements in BD, OCD accompanied by alcohol addiction, opioid addiction, and health anxiety. Dr. Niraj administered 9 mL of 0.2% ropivacaine and 20 mg of depot methylprednisolone for the SGB procedure [1].

I would like to commend the authors for their utilization of SGB for MHDs. There is extensive literature on the use of SGB for PTSD [2] as well as anxiety [3] and depression [3]. To the best of my knowledge, SGB has not been reported as effective in treating OCD, BD, or opioid withdrawal symptoms. I also agree that a common aspect of the tr-MHDs mentioned above is autonomic dysfunction, which may be linked to immune dysfunction. I would like to note that there has been a previous report indicating that SGB can significantly improve symptoms of schizophrenia [4], a condition that is also linked to autonomic dysfunction [5]. Given that sympathetic dysfunction is widespread in various mental health conditions, it is probable that other potential uses for SGB will be identified in the near future.

When performing an SGB, bupivacaine and ropivacaine are commonly used as anesthetics without the addition of depot methylprednisolone or other steroids. Bupivacaine was first reported as a treatment for PTSD via SGB by the primary author in 2008 [6]. We strongly recommend avoiding the use of steroids in SGB procedures, especially particulate steroids. Routine administration of corticosteroid in these injections might be questioned because of the risk of intra-arterial injection into the vertebral, carotid, or spinal radicular artery. Specifically, particulate corticosteroids (suspensions such as methylprednisolone acetate) can cause an embolic stroke if unintentionally injected into any of these arteries [7]. Furthermore, the effectiveness of mixing steroids with local anesthetics for SGB has not been established, and the potential risks outweigh any possible benefits.

  1. Research funding: None declared.

  2. Author contributions: EL drafted concept for the letter. KM drafted and edited letter to the editor.

  3. Competing interests: Not applicable.

  4. Data availability: Not applicable.

References

[1] Niraj G, Karanth V, Niraj S, Charan N. Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series. Scand J Pain. 2025;25(1):1–4. Epub 2025/02/01 20:44. 10.1515/sjpain-2024-0071. PubMed PMID: 39889737.Search in Google Scholar PubMed

[2] Olmsted KL, Bartoszek M, Mulvaney S, McLean B, Turabi A, Young R, et al. Effect of stellate ganglion block treatment on posttraumatic stress disorder symptoms: a randomized clinical trial. JAMA Psychiatry. 2020 Feb;77(2):130–8. 10.1001/jamapsychiatry.2019.3474.Search in Google Scholar PubMed PubMed Central

[3] Li Y, Loshak H. Stellate ganglion block for the treatment of post-traumatic stress disorder, depression, and anxiety. Can J Health Technol. 2021 Mar;1(3):1–30. PMID: 34255448.10.51731/cjht.2021.41Search in Google Scholar

[4] Takano M, Takano Y, Sato I. Unexpected beneficial effect of stellate ganglion block in a schizophrenic patient. Can J Anesth. 2002 Aug;49(7):758–9. PMID: 12193502. 10.1007/BF03017464.Search in Google Scholar PubMed

[5] Bär KJ. Cardiac autonomic dysfunction in patients with schizophrenia and their healthy relatives–a small review. Front Neurol. 2015 Jun;6:139. PMID: 26157417. PMCID: PMC4478389. 10.3389/fneur.2015.00139.Search in Google Scholar PubMed PubMed Central

[6] Lipov EG, Joshi JR, Lipov S, Sanders SE, Siroko MK. Cervical sympathetic blockade in a patient with post-traumatic stress disorder: a case report. Annals of Clinical Psychiatry. 2008 Jan;20(4):227–8. 10.1080/10401230802435518. PMID: 19034755.Search in Google Scholar PubMed

[7] Rauck RL, Rathmell JP. Complications associated with stellate ganglion and lumbar sympathetic blocks. Complications Reg Anesth Pain Med. 2007 Jan;44:203–12. 10.1016/B978-1-4160-2392-0.50024-8.Search in Google Scholar
Received: 2025-02-28
Revised: 2025-03-07
Accepted: 2025-03-10
Published Online: 2025-04-01

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  3. Quantitative sensory testing – Quo Vadis?
  4. Stellate ganglion block for mental disorders – too good to be true?
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  33. Persistent severe pain following groin hernia repair: Somatosensory profiles, pain trajectories, and clinical outcomes – Synopsis of a PhD thesis
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  37. Neural networks involved in painful diabetic neuropathy: A systematic review
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  40. Impact of respiration on abdominal pain thresholds in healthy subjects – A pilot study
  41. Measuring pain intensity in categories through a novel electronic device during experimental cold-induced pain
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  45. Investigation of endocannabinoids in plasma and their correlation with physical fitness and resting state functional connectivity of the periaqueductal grey in women with fibromyalgia: An exploratory secondary study
  46. Educational Case Reports
  47. Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series
  48. Regaining the intention to live after relief of intractable phantom limb pain: A case study
  49. Trigeminal neuralgia caused by dolichoectatic vertebral artery: Reports of two cases
  50. Short Communications
  51. Neuroinflammation in chronic pain: Myth or reality?
  52. The use of registry data to assess clinical hunches: An example from the Swedish quality registry for pain rehabilitation
  53. Letter to the Editor
  54. Letter to the Editor For: “Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series”
  55. Corrigendum
  56. Corrigendum to “Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population”
https://doi.org/10.1515/sjpain-2025-0014
Creative Commons
BY 4.0

Articles in the same Issue

  1. Editorial Comment
  2. Abstracts presented at SASP 2025, Reykjavik, Iceland. From the Test Tube to the Clinic – Applying the Science
  3. Quantitative sensory testing – Quo Vadis?
  4. Stellate ganglion block for mental disorders – too good to be true?
  5. When pain meets hope: Case report of a suspended assisted suicide trajectory in phantom limb pain and its broader biopsychosocial implications
  6. Transcutaneous electrical nerve stimulation – an important tool in person-centered multimodal analgesia
  7. Clinical Pain Researches
  8. Exploring the complexities of chronic pain: The ICEPAIN study on prevalence, lifestyle factors, and quality of life in a general population
  9. The effect of peer group management intervention on chronic pain intensity, number of areas of pain, and pain self-efficacy
  10. Effects of symbolic function on pain experience and vocational outcome in patients with chronic neck pain referred to the evaluation of surgical intervention: 6-year follow-up
  11. Experiences of cross-sectoral collaboration between social security service and healthcare service for patients with chronic pain – a qualitative study
  12. Completion of the PainData questionnaire – A qualitative study of patients’ experiences
  13. Pain trajectories and exercise-induced pain during 16 weeks of high-load or low-load shoulder exercise in patients with hypermobile shoulders: A secondary analysis of a randomized controlled trial
  14. Pain intensity in anatomical regions in relation to psychological factors in hypermobile Ehlers–Danlos syndrome
  15. Opioid use at admittance increases need for intrahospital specialized pain service: Evidence from a registry-based study in four Norwegian university hospitals
  16. Topically applied novel TRPV1 receptor antagonist, ACD440 Gel, reduces temperature-evoked pain in patients with peripheral neuropathic pain with sensory hypersensitivity, a randomized, double-blind, placebo-controlled, crossover study
  17. Pain and health-related quality of life among women of childbearing age in Iceland: ICEPAIN, a nationwide survey
  18. A feasibility study of a co-developed, multidisciplinary, tailored intervention for chronic pain management in municipal healthcare services
  19. Healthcare utilization and resource distribution before and after interdisciplinary pain rehabilitation in primary care
  20. Measurement properties of the Swedish Brief Pain Coping Inventory-2 in patients seeking primary care physiotherapy for musculoskeletal pain
  21. Understanding the experiences of Canadian military veterans participating in aquatic exercise for musculoskeletal pain
  22. “There is generally no focus on my pain from the healthcare staff”: A qualitative study exploring the perspective of patients with Parkinson’s disease
  23. Observational Studies
  24. Association between clinical laboratory indicators and WOMAC scores in Qatar Biobank participants: The impact of testosterone and fibrinogen on pain, stiffness, and functional limitation
  25. Well-being in pain questionnaire: A novel, reliable, and valid tool for assessment of the personal well-being in individuals with chronic low back pain
  26. Properties of pain catastrophizing scale amongst patients with carpal tunnel syndrome – Item response theory analysis
  27. Adding information on multisite and widespread pain to the STarT back screening tool when identifying low back pain patients at risk of worse prognosis
  28. The neuromodulation registry survey: A web-based survey to identify and describe characteristics of European medical patient registries for neuromodulation therapies in chronic pain treatment
  29. A biopsychosocial content analysis of Dutch rehabilitation and anaesthesiology websites for patients with non-specific neck, back, and chronic pain
  30. Topical Reviews
  31. An action plan: The Swedish healthcare pathway for adults with chronic pain
  32. Team-based rehabilitation in primary care for patients with musculoskeletal disorders: Experiences, effect, and process evaluation. A PhD synopsis
  33. Persistent severe pain following groin hernia repair: Somatosensory profiles, pain trajectories, and clinical outcomes – Synopsis of a PhD thesis
  34. Systematic Reviews
  35. Effectiveness of non-invasive vagus nerve stimulation vs heart rate variability biofeedback interventions for chronic pain conditions: A systematic review
  36. A scoping review of the effectiveness of underwater treadmill exercise in clinical trials of chronic pain
  37. Neural networks involved in painful diabetic neuropathy: A systematic review
  38. Original Experimental
  39. Knowledge, attitudes, and practices of transcutaneous electrical nerve stimulation in perioperative care: A Swedish web-based survey
  40. Impact of respiration on abdominal pain thresholds in healthy subjects – A pilot study
  41. Measuring pain intensity in categories through a novel electronic device during experimental cold-induced pain
  42. Robustness of the cold pressor test: Study across geographic locations on pain perception and tolerance
  43. Experimental partial-night sleep restriction increases pain sensitivity, but does not alter inflammatory plasma biomarkers
  44. Is it personality or genes? – A secondary analysis on a randomized controlled trial investigating responsiveness to placebo analgesia
  45. Investigation of endocannabinoids in plasma and their correlation with physical fitness and resting state functional connectivity of the periaqueductal grey in women with fibromyalgia: An exploratory secondary study
  46. Educational Case Reports
  47. Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series
  48. Regaining the intention to live after relief of intractable phantom limb pain: A case study
  49. Trigeminal neuralgia caused by dolichoectatic vertebral artery: Reports of two cases
  50. Short Communications
  51. Neuroinflammation in chronic pain: Myth or reality?
  52. The use of registry data to assess clinical hunches: An example from the Swedish quality registry for pain rehabilitation
  53. Letter to the Editor
  54. Letter to the Editor For: “Stellate ganglion block in disparate treatment-resistant mental health disorders: A case series”
  55. Corrigendum
  56. Corrigendum to “Patient characteristics in relation to opioid exposure in a chronic non-cancer pain population”
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