Living in a Constant Alarm State: A Case Report on Stellate Ganglion Block for PTSD
Daniel — Age 46, South West England
Civil Engineer • Complex childhood trauma • Self-pay patient
The Presentation
A man carrying decades of unprocessed trauma
Daniel, a 46-year-old civil engineer from the South West of England, had been living in the shadow of trauma for most of his adult life. His childhood had been marked by significant adversity — the early loss of his father, exposure to a volatile home environment, and witnessing the emotional and physical abuse of a parent. Many of the memories from this period remained fragmented and suppressed; he acknowledged that he had spent years avoiding confronting them.
By the time he sought specialist input, the cumulative toll of these early experiences was manifesting across every dimension of his life. He described a persistent, heavy sense of emotional disconnection from the people around him. He felt foggy, overwhelmed, and unable to fully concentrate. A constant undercurrent of hyperarousal left him feeling perpetually on edge — reactive, irritable, and unable to switch off. At times, he experienced unsettling episodes of depersonalisation: a strange detachment from his own sense of self and surroundings.
He had been in regular weekly counselling, which he found supportive, but despite this ongoing engagement, his symptoms remained persistent and disabling. He had not yet undertaken structured trauma-focused therapies such as EMDR or PTSD-directed CBT. He had previously trialled SSRIs without benefit, and was not on any regular psychotropic medication. His only medical history of note was well-controlled asthma.
A previous GP assessment had identified anxiety and OCD traits. A specialist consulted about his depersonalisation symptoms had noted possible features of depersonalisation/derealisation but had not recommended specific treatment at that stage. Daniel had not received a formal PTSD diagnosis prior to this referral.
He came to PainSpa specifically to explore the emerging role of Stellate Ganglion Block (SGB) in the management of PTSD — a treatment he had researched independently and wished to discuss with a specialist.
Symptom Assessment
What the PTSD checklist revealed
Prior to his initial consultation, Daniel completed the standardised PTSD Checklist (PCL). His responses painted a clear and consistent picture: significant trauma-related symptom burden spanning all five major PTSD symptom clusters. Below is a summary of how his symptoms grouped — a profile that is characteristic of patients with prominent autonomic dysregulation underpinning their PTSD.
- Recurring distressing memories and images of past trauma
- Disturbing dreams related to past experiences
- Flashback episodes — feeling as though trauma is happening again
- Actively avoiding thoughts or feelings related to past trauma
- Avoiding situations or activities that act as reminders
- Difficulty recalling important aspects of traumatic events
- Emotional numbness and disconnection from others
- Loss of interest in previously enjoyed activities
- A sense that the future feels foreshortened or uncertain
- Persistent hypervigilance — constantly watchful and on guard
- Heightened startle response
- Irritability, sleep disturbance, difficulty concentrating
The Treatment Journey
A carefully structured, stepwise approach
Dr Krishna’s approach centres on a thorough assessment followed by a transparent, evidence-informed discussion — never a one-size-fits-all recommendation. For Daniel, this meant ensuring he had a full understanding of the neurobiology of PTSD, realistic expectations for what SGB could and could not achieve, and a clear plan for what would come next.
The PainSpa Approach
Four pillars of PTSD intervention at PainSpa
Managing PTSD effectively requires more than a single treatment. Dr Krishna’s approach to patients like Daniel is grounded in a structured, multi-layered framework that respects the complexity of trauma and places the patient at the centre of every decision.
Outcome
What changed for Daniel at four weeks
Approximately four weeks following his Stellate Ganglion Block, Daniel reported a meaningful and wide-ranging improvement in his quality of life. For someone who had been living with the physiological weight of unresolved trauma for decades, the changes — though still evolving — were striking.
Key improvements reported at four-week follow-up
- Intrusive thoughts and mental ‘noise’ reduced in intensity and frequency — they came and went rather than persisting continuously
- Significantly less overwhelmed by everyday stress and no longer in a constant state of hyperarousal
- Markedly calmer overall — described as a palpable reduction in the feeling of being constantly on edge
- Improved confidence in occupational settings, performing more effectively at work
- Renewed engagement in social situations previously avoided
- Returned to the gym and was enjoying physical exercise — a meaningful indicator of restored motivation and capacity
- Significant reduction in alcohol consumption, which had previously been used to manage symptoms
- Improved eating patterns and appetite
- Better able to cope with persistent depersonalisation symptoms, even though these had not directly improved
Dr Krishna was particularly encouraged by the breadth of improvement across domains extending well beyond symptom scores — including return to exercise, reduced reliance on alcohol, and improved social confidence. These functional gains are often the most meaningful indicators of progress in PTSD recovery.
It is worth noting that Daniel’s depersonalisation symptoms did not respond to SGB — a finding consistent with the current understanding that dissociative features of PTSD may require targeted psychological intervention beyond what an autonomic intervention alone can address.
Looking Ahead
The next steps in Daniel’s recovery
The SGB procedure has done its intended job: created a window of reduced physiological arousal during which Daniel is now better placed to engage with structured trauma-focused therapies. Dr Krishna has left the door open for further specialist input and outlined the following pathway.
Your Specialist
About Dr Murli Krishna
Dr Krishna is a highly experienced Consultant in Pain Medicine practising at PainSpa’s clinics in Bristol, including Willow Surgery in Downend and the Chesterfield Nuffield Hospital in Clifton. He specialises in the diagnosis and interventional management of complex chronic pain and autonomic conditions, with a growing practice in Stellate Ganglion Block for PTSD and related disorders.
His philosophy is rooted in a comprehensive, patient-centred assessment: understanding the precise physiological mechanisms driving a patient’s symptoms, applying appropriately targeted interventions, and situating these within a broader management plan that places psychological recovery at its core. He approaches PTSD with the same rigour and compassion that characterises his work across all complex conditions.
Dr Krishna consults in person and via telephone or video, and sees patients on a self-pay basis. Patients interested in exploring Stellate Ganglion Block for PTSD are encouraged to contact PainSpa to arrange an initial assessment consultation.