Clinical Evidence Review

Stellate Ganglion Block in Post-Traumatic Stress Disorder

A Comprehensive Evidence-Based Assessment for the Interventional Pain Practitioner

PainSpa Clinical Team • 2026

Executive Summary

Key Points at a Glance

• Stellate ganglion block (SGB) is an emerging, evidence-supported treatment option for PTSD, especially when symptoms are driven by hyperarousal, such as being constantly on edge, jumpy, unable to sleep, or stuck in “fight or flight” mode.
• The strongest trial to date, published in JAMA Psychiatry in 2020, showed that two right-sided SGB injections led to a clinically meaningful reduction in PTSD symptoms compared with sham treatment.
• SGB appears to work best as an adjunct rather than a complete replacement for established treatment. In particular, it may help patients engage more effectively with trauma-focused psychotherapy such as CPT or prolonged exposure.
• The procedure has a generally favourable safety profile, especially when performed under real-time ultrasound guidance by an experienced clinician.
• SGB is not yet a first-line guideline treatment for PTSD, but the evidence is now strong enough for it to be considered a promising second-line or adjunctive option in carefully selected patients.
• There is also emerging interest in whether SGB may work alongside other treatments, including ketamine, in highly treatment-resistant cases.
• Pulsed radiofrequency (PRF) of the stellate ganglion is theoretically interesting, but at present there are no PTSD-specific clinical trials, so it should still be regarded as investigational.

Background: PTSD in Clinical Practice

Epidemiology and Prevalence

Post-traumatic stress disorder (PTSD) is a common and often disabling condition. Around 6% of the general population will experience PTSD at some point in life, although the true figure may be higher because many cases go undiagnosed. Women are diagnosed more often than men, and the risk is especially high after interpersonal trauma, such as sexual violence, domestic abuse, torture, or kidnapping.

In everyday clinical practice, PTSD is often missed or under-recognised. One reason is that many patients do not initially present saying, “I think I have PTSD.” Instead, they may present with poor sleep, pain, stomach symptoms, palpitations, headaches, anxiety, or unexplained physical symptoms. PTSD also commonly overlaps with depression, anxiety, substance misuse, chronic pain, and autonomic symptoms, which can make the picture more complex.

This overlap matters because it helps explain why treatments that affect the nervous system, rather than just mood or thought patterns, may have a role in selected patients.

Clinical Presentation and Symptom Clusters

PTSD is usually described in terms of four main symptom clusters:

• Intrusive symptoms: flashbacks, nightmares, intrusive memories, or intense distress when reminded of trauma.
• Avoidance: trying hard to avoid thoughts, conversations, people, places, or situations linked to the trauma.
• Negative changes in mood and thinking: emotional numbing, guilt, shame, detachment, loss of interest, hopelessness, or persistent negative beliefs.
• Alterations in arousal and reactivity: hypervigilance, exaggerated startle, poor sleep, irritability, restlessness, poor concentration, and a constant sense of threat.

From the perspective of SGB, the hyperarousal cluster is particularly important. Many patients describe feeling as though their nervous system is permanently “stuck on,” even when they rationally know they are safe. This constant physiological overactivation is one reason SGB has attracted attention as a treatment option.

Two-thirds of patients present with moderate to severe symptoms. Risk also varies depending on the type of trauma. Interpersonal trauma carries a much higher PTSD conversion risk than impersonal trauma. For example, estimates suggest PTSD develops in approximately 17.4% after rape and 11.3% after kidnapping, compared with around 0.2% after natural disasters.

Clinical Phenotypes Relevant to Treatment Selection

Not all PTSD looks the same. Some patients are dominated by fear and hypervigilance. Others by emotional numbness, anger, impulsivity, dissociation, or bodily symptoms. This matters because different symptom patterns may respond differently to treatment, including SGB.

The practical message is that SGB is unlikely to be a universal PTSD treatment for all symptom profiles, but it may be particularly valuable in patients whose symptoms are dominated by fight-or-flight physiology.

Complex PTSD and Dissociative Subtype

The ICD-11 also recognises Complex PTSD (C-PTSD), which usually develops after prolonged, repeated, or inescapable trauma such as childhood abuse, coercive control, or torture. These patients often have the core PTSD symptoms, but also marked difficulties with emotion regulation, self-worth, and relationships.

A related presentation is the dissociative subtype, where patients may experience depersonalisation, derealisation, emotional shut-down, and a “freeze” response. From a nervous system point of view, this may be somewhat different from classic hyperarousal. While hyperarousal is often associated with a sympathetic dominant state, dissociation may reflect a more complex freeze / shutdown pattern.

For that reason, SGB is less likely to be the main answer in predominantly dissociative PTSD. However, many patients are mixed rather than pure presentations. Someone may have dissociation and severe hypervigilance, poor sleep, panic surges, or somatic overactivation. In those cases, SGB may still have a useful role, provided expectations are realistic.

Anatomy, Procedure, and Technical Considerations

Cervical Sympathetic Chain Anatomy

The stellate ganglion forms part of the cervical sympathetic chain, a network of nerves that helps regulate many automatic body functions, including heart rate, blood vessel tone, sweating, stress responses, and aspects of threat processing.

The cervical sympathetic trunk contains four ganglia:

• Superior cervical ganglion (SCG): the largest, located higher in the neck and involved in sympathetic supply to the head, face, and important brain-related pathways.
• Middle cervical ganglion: typically around the C6 level and a main target for standard SGB.
• Intermediate cervical ganglion: lies near the vertebral artery.
• Inferior cervical / stellate ganglion: usually around C7–T1, often fused into the classic stellate ganglion.

In practice, the most common approach is to perform the block at C6, where the anatomy is safer and the local anaesthetic can spread downward to influence the stellate ganglion. This is one reason SGB is often described as a functional block of the cervical sympathetic chain, rather than a literal need to hit the fused stellate ganglion directly.

Standard SGB Protocol

The best-supported protocol from the PTSD literature is right-sided injection first, at the C6 level, using 7–10 mL of 0.5% Bupivacaine or Ropivacaine under real-time ultrasound guidance, repeated as a second injection around two weeks later.

This matters because some early negative studies used different volumes, different techniques, or older methods, so not all “SGB studies” are directly comparable.

Dual-Level Cervical Sympathetic Block (C4/C6)

Some clinicians extend beyond standard C6 SGB and perform a dual-level cervical sympathetic block, often at C4 and C6, with the aim of influencing more of the sympathetic chain, including the superior cervical ganglion.

The theory is appealing: if PTSD symptoms are being maintained by a wider dysregulated sympathetic network, then a broader block might lead to a stronger or more durable effect. Case reports and retrospective studies suggest that some patients with more severe or refractory symptoms may improve significantly with this approach.

That said, it is important to be honest: there is no head-to-head randomised trial showing that dual-level blockade is definitely superior to standard C6 SGB. At present, it is best viewed as a reasonable escalation strategy in selected cases, rather than proven standard care.

Optimal Timing When Combined with Psychotherapy

One of the most interesting developments in recent years is not simply whether SGB works, but when it works best.

Evidence increasingly suggests that SGB may be particularly helpful when used before starting trauma-focused psychotherapy, very early during a course of therapy, or as a rescue strategy after limited response to psychotherapy.

Mechanism of Action

Overview

One of the most common questions patients ask is: how can an injection in the neck affect trauma symptoms?

The honest answer is that the full mechanism is still being worked out. However, the current evidence suggests that SGB is not simply “numbing a nerve for a few hours.” If that were all it did, one would expect benefits to last only as long as the local anaesthetic. In practice, some patients experience improvement for weeks or months, which suggests that SGB may trigger a broader reset or recalibration within the autonomic nervous system and related brain circuits.

Locus Coeruleus–Amygdala Circuit Disruption

The most compelling recent mechanistic work comes from preclinical research suggesting that SGB influences the locus coeruleus–amygdala pathway, an important part of the brain’s fear and arousal system.

In simple terms, this pathway helps drive threat detection, hypervigilance, sympathetic activation, and the physical experience of alarm.

A 2025 animal study suggested that SGB reduced activity in this pathway, lowered norepinephrine signalling, and weakened conditioned fear responses. Although animal data cannot be treated as proof of clinical effect in humans, it fits remarkably well with what many patients report after a successful block: less inner alarm, less reactivity, less autonomic surge.

Sympathetic Nervous System ‘Reset’

The most practical clinical explanation is that SGB temporarily interrupts the sympathetic stress loop, allowing the nervous system to move out of an entrenched fight-or-flight state.

This may matter in PTSD because symptoms are not only cognitive or emotional; they are often physiological:

• constant muscle tension
• racing heart
• sweating
• exaggerated startle
• poor sleep
• scanning for danger
• inability to settle

By lowering sympathetic outflow and reducing stress signalling, SGB may help some patients feel safer in their own body, sometimes for the first time in a long while.

Neuroimaging Evidence

Although human imaging studies are still limited, the available evidence is intriguing. Small studies using brain imaging after cervical sympathetic blockade have shown changes in areas involved in fear processing, emotional regulation, prefrontal control, and autonomic integration. These findings support the idea that SGB may do more than just calm the body temporarily; it may also affect the balance between limbic alarm systems and higher regulatory networks.

Unanswered Mechanistic Questions

• Why is the right side usually preferred first?
• Why do some patients respond dramatically while others do not?
• Does SGB mainly help hyperarousal, or can it also influence intrusive memories and emotional numbing?
• Can repeated SGB lead to more durable nervous system retraining?
• Is there a subgroup of PTSD patients who are especially likely to respond?

These uncertainties should not stop careful clinical use, but they do mean SGB should still be presented as a promising and evolving treatment, rather than a miracle cure.

Clinical Evidence for SGB in PTSD

Landmark Randomised Controlled Trial (JAMA Psychiatry, 2020)

The most important modern trial is the 2020 JAMA Psychiatry randomised controlled study in 113 active-duty military personnel.

• Two right-sided SGBs were given at weeks 0 and 2.
• Local anaesthetic used was 0.5% ropivacaine, 7–10 mL.
• The group receiving SGB had a 12.6-point reduction in CAPS-5.
• The sham group had a 6.1-point reduction.
• The difference was statistically significant (p=0.01).

This trial matters because it demonstrated that SGB was better than sham, not just better than no treatment.

The study also suggested that patients with more severe baseline symptoms may sometimes have more room for improvement. The authors concluded that SGB warrants further study as a PTSD treatment adjunct, which remains a fair and balanced summary today.

Combined SGB + Psychotherapy Trials

SGB + Cognitive Processing Therapy (CPT) — Bryan et al. 2025

A 2025 open-label randomised wait-list trial looked at SGB given before versus after a course of massed CPT.

• Both groups improved.
• Giving SGB before CPT led to faster symptom reduction.
• Patients who did not reach a good endpoint with CPT alone could still improve when SGB was added later.

This supports the idea that SGB may be particularly useful as a way of reducing the physiological burden of PTSD so that patients can engage more effectively with therapy.

SGB + Prolonged Exposure (PE) — Peterson et al. 2022

A smaller non-randomised study combined SGB with massed prolonged exposure therapy.

• Mean PCL-5 reduction of 32 points.
• Over 90% achieved clinically significant change.
• 50% no longer met PTSD criteria at one month.

This was a small study, so it should not be over-interpreted, but it adds to the growing theme that SGB may be most powerful when used as part of an integrated treatment pathway.

Meta-Analytic Evidence

A 2025 systematic review and meta-analysis pooled the available evidence and found that SGB was associated with a significant improvement in PTSD symptom scores compared with controls. The pooled mean difference was −6.24 points on CAPS measures, favouring SGB. Meta-analysis is useful because it looks across multiple studies, but it is also only as strong as the studies included. The overall message is encouraging, but the authors were right to note that more high-quality trials are still needed.

SGB in Anxiety Disorders Beyond PTSD

SGB has also been studied outside PTSD, including in generalised anxiety disorder (GAD).

A 2025 double-blind RCT in 128 patients with GAD reported that SGB improved:

• overall anxiety scores
• sleep quality
• total sleep time

It also found changes in neurotransmitters consistent with reduced sympathetic activation.

This does not prove that GAD and PTSD are the same, but it does support the broader idea that SGB may be useful in conditions characterised by persistent overactivation of the autonomic nervous system. It is also worth noting that a case report described worsening anxiety after a left-sided SGB, which improved after a right-sided block, again underlining the importance of laterality.

Retrospective Series and Case Data

Retrospective studies and case series are lower down the evidence hierarchy than randomised trials, but they still provide useful real-world information.

Taken together, these studies suggest several clinically useful points: SGB can help a meaningful subset of patients; some patients who do not respond to a right-sided block may respond to a left-sided block; and more complex or repeated sympathetic blockade may be useful in selected refractory cases.

Safety Profile and Contraindications

Overall Risk Profile

SGB is generally considered a low-risk procedure when performed properly, particularly under ultrasound guidance. Historical data from very large older series suggested serious adverse events occurred in around 1.7 per 1,000 procedures. Modern practice is safer because ultrasound allows the clinician to visualise important structures and guide the needle in real time.

Common Expected Effects (Not Complications)

• Horner’s syndrome: drooping eyelid, small pupil, and reduced sweating on the treated side. This usually means the block has worked and typically resolves within hours.
• Temporary hoarseness: can occur because nearby nerves are affected transiently.
• Temporary heaviness or odd sensations in the arm or neck: usually short-lived.

Serious Adverse Events

Serious complications are rare, but they do exist and should be discussed honestly.

• intravascular injection / local anaesthetic toxicity
• pneumothorax
• vertebral artery injection
• epidural or high spinal spread
• bleeding
• infection

The good news is that careful technique, appropriate patient selection, and ultrasound guidance all make these problems far less likely.

Contraindications

SGB vs. Other Novel PTSD Interventions

Comparative Overview

Several newer or non-standard treatments are now discussed in PTSD care. Patients often ask how SGB compares with ketamine, MDMA-assisted therapy, and other emerging options.

The practical advantage of SGB is that it is already available, procedurally familiar to interventional pain clinicians, relatively low burden for patients, and capable of rapid effect in the right patient.

Ketamine

Ketamine has attracted major interest in psychiatry, especially for treatment-resistant depression. In PTSD, however, the evidence is more mixed. A 2025 systematic review of seven RCTs found meaningful PTSD improvement in only two of the seven studies. Multi-infusion protocols appeared more effective than single doses, but the overall evidence quality remained limited. Current VA/DoD guidelines recommend against ketamine specifically for PTSD, although they acknowledge it may still be appropriate where comorbid treatment-resistant depression is a major issue. So ketamine is not “bad,” but its role in PTSD is more selective and less clearly established than many headlines suggest.

MDMA-Assisted Therapy

MDMA-assisted therapy has shown impressive results in research studies, with large reductions in symptom burden in some trials. However, it remains a complex area. The main issues are regulatory uncertainty, need for extensive infrastructure, long treatment sessions, highly specialised therapist support, and concerns raised about blinding and trial validity. In other words, MDMA-assisted therapy may become very important in the future, but it is not currently a routine clinical option for most patients.

SGB + Ketamine: Combination Approach

There is emerging interest in whether SGB and ketamine might work well together in selected, treatment-resistant patients. Preliminary case-series data suggest that combining cervical sympathetic blockade with ketamine infusions may produce larger improvements than either treatment alone, particularly in complex patients with PTSD and traumatic brain injury. This is promising, but still early. At present, this should be regarded as investigational, not standard treatment.

Patient Selection and Ideal Candidates

Ideal Candidates for SGB

Based on the current evidence, SGB may be particularly worth considering in patients who have:

• moderate to severe PTSD
• significant hyperarousal, poor sleep, exaggerated startle, or autonomic overactivation
• stable medications
• limited progress with conventional treatment
• difficulty engaging in therapy because their nervous system feels too activated
• a preference for an interventional approach as part of a broader plan
• a need for faster symptom reduction or help moving out of a persistent fight-or-flight state

Psychiatric Exclusions

Important caution is needed in patients with:

• active psychosis
• bipolar disorder
• moderate to severe traumatic brain injury
• active substance misuse
• recent suicidality

Comparative Patient Selection

Treatment Algorithm and Sequencing

Standard First-Line Treatment

First-line treatment for PTSD remains trauma-focused psychotherapy, especially CPT, PE, or EMDR, with SSRIs / SNRIs where medication is needed.

This remains important. Pain Spa should not present SGB as replacing all established care. Instead, SGB is best described as an adjunctive option for the right patient, particularly when physiological overactivation is a major barrier to recovery.

Proposed Treatment Sequencing Framework

This sequencing fits the current literature and avoids SGB as a first-line standalone answer.

Managing SGB Non-Responders

This is important because not responding to the first SGB does not automatically mean the whole approach has failed.

Dissociative PTSD — Special Considerations

SGB in Dissociative Phenotype

There are currently no direct studies examining SGB specifically in dissociative PTSD. From a mechanistic point of view, there are good reasons to think the response may be less predictable.

SGB seems most likely to help symptoms related to:

• hyperarousal
• startle
• poor sleep
• sympathetic overdrive
• autonomic reactivity

Dissociation may reflect a somewhat different pattern of nervous system dysregulation. That does not mean SGB has no role, but it does mean patients with strong dissociative symptoms should be counselled that improvement may be partial or selective, rather than complete.

Evidence-Based Treatments for Dissociative PTSD

For predominantly dissociative cases, SGB may still have value as an adjunct, particularly if there is also marked hyperarousal, but it is rarely likely to be the only treatment needed.

Pulsed Radiofrequency (PRF) Ablation of the Stellate Ganglion

Current Evidence Status

At present, no clinical trials have specifically examined PRF of the stellate ganglion for PTSD. That point needs to be made clearly. PRF is often interesting theoretically, but for PTSD the evidence base still rests on local anaesthetic SGB, not PRF.

Evidence from Pain Conditions

PRF has been studied in other conditions such as:

• postherpetic neuralgia
• CRPS
• post-mastectomy pain

In some of these conditions it appears to offer longer duration of benefit, fewer repeat procedures, and less obvious sympathetic block signs such as Horner’s syndrome. That raises interesting questions for PTSD, but these are still questions, not answers.

Theoretical Advantages of PRFL Treatment in PTSD

The absence of Horner’s syndrome is especially interesting for research, because it would make proper blinded trials easier. For now, however, PRF should be described as promising but experimental in PTSD.

11. Current Guideline Positioning

This is important for patient education. SGB is not yet a mainstream first-line guideline treatment, but neither is it fringe or evidence-free. The most honest way to present it is as a credible, evidence-supported adjunctive intervention that is ahead of formal guideline adoption.

Clinical Verdict: What Is Worth Trying and What Is Not

This is the most practical section for patients and clinicians alike.

Practical Guidance for the Clinician

Shared Decision-Making

• Patients considering SGB should be counselled clearly that it is an off-label use.
• The evidence is encouraging but still evolving.
• It is not a cure.
• It may be most helpful for hyperarousal symptoms.
• It works best as part of a broader care pathway.
• Expectations should be realistic.

Setting Up a PTSD SGB Programme

• psychiatric and medical screening
• baseline symptom scoring such as PCL-5
• coordination with therapy where possible
• proper informed consent
• ultrasound-guided right-sided SGB at C6
• a second injection if appropriate
• structured follow-up
• clear escalation planning for non-responders

Symptom Monitoring

It is often useful to monitor symptom clusters separately:

• hyperarousal
• sleep
• intrusive symptoms
• avoidance
• mood / cognition
• dissociation

SGB for PTSD at Pain Spa (Dual Reset on both sides)

At Pain Spa, stellate ganglion block (SGB) for PTSD is offered within a specialist, ultrasound-guided, evidence-informed treatment pathway designed to maximise both safety and the chance of a meaningful clinical response. Our approach reflects not only the published evidence, but also wider international procedural practice and extensive experience in image-guided pain interventions.

Dr Krishna has considerable experience in ultrasound-guided interventional procedures, including technically demanding treatments in the neck and around major nerves. This is particularly relevant in stellate ganglion treatment, where success depends not simply on performing an injection, but on accurate anatomical targeting, careful technique, appropriate patient selection, and thoughtful treatment planning.

At Pain Spa, the standard protocol for PTSD is more comprehensive than the traditional single-sided approach described in some of the earlier literature. Our usual approach is an initial dual right-sided block, typically targeting the C6 level together with the C3 or C4 level, followed by left-sided injections approximately 24 hours later. In our view, this broader cervical sympathetic blockade offers the best chance of achieving a meaningful response by addressing the sympathetic chain more fully, rather than relying on a single unilateral injection alone.

This type of protocol is increasingly used by experienced centres internationally treating trauma-related autonomic dysfunction and hyperarousal states. Although the highest-level randomised trial evidence has focused mainly on right-sided C6 injections, real-world specialist practice has evolved, with many centres adopting broader bilateral or dual-level strategies in an effort to improve outcomes in patients with more established or severe symptoms.

The procedure at Pain Spa is performed under real-time ultrasound guidance, usually using ropivacaine, with careful observation of expected block signs and close assessment of symptom response afterwards. Decisions regarding further treatment are guided not only by protocol, but by the individual patient’s presentation, pattern of symptoms, and response to earlier injections.

Importantly, SGB for PTSD is not presented at Pain Spa as a miracle cure or as a substitute for good trauma care. It is best understood as a specialist adjunctive treatment, particularly relevant for patients whose symptoms are dominated by hyperarousal, autonomic overactivation, exaggerated startle, poor sleep, and a persistent fight-or-flight state. For the right patient, reducing that physiological alarm response can create an important opportunity for better function, greater emotional steadiness, and improved engagement with wider psychological treatment and recovery.

Key References

Randomised Controlled Trials and Meta-Analyses

1. Rae Olmsted KL, Bartoszek M, Mulvaney S, et al. Effect of Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Psychiatry. 2020;77(2):130–138.
2. Bryan CJ, Lynch J, Bryan AO, et al. Effectiveness of Combined Cognitive Processing Therapy With Stellate Ganglion Block: An Open-Label Randomized Wait-List Clinical Trial. Psychotherapy and Psychosomatics. 2025.
3. Yang Y, Pu R, Zhang D, et al. Stellate Ganglion Blockade for the Treatment of Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis. Autonomic Neuroscience: Basic & Clinical. 2025.
4. Peterson AL, Straud CL, Young-McCaughan S, et al. Combining a Stellate Ganglion Block With Prolonged Exposure Therapy for Posttraumatic Stress Disorder: A Nonrandomized Clinical Trial. Journal of Traumatic Stress. 2022.
5. Liu N, Ma Q, Zhou M, et al. Efficacy and Exploratory Analysis of Potential Mechanisms of Stellate Ganglion Block in Alleviating Sleep Disturbance in Generalized Anxiety Disorder: A Randomized Controlled Trial Excluding Comorbid Depression. Frontiers in Neurology. 2025.
6. Bohus M, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder Compared With Cognitive Processing Therapy in Complex Presentations of PTSD in Women Survivors of Childhood Abuse. JAMA Psychiatry. 2020.
7. Mitchell JM, Bogenschutz M, Lilienstein A, et al. MDMA-assisted Therapy for Severe PTSD: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study. Nature Medicine. 2021.
8. Yin L, Lu A, Le GH, et al. Effects of Intravenous Ketamine on Posttraumatic Stress Disorder (PTSD): A Systematic Review. Acta Psychiatrica Scandinavica. 2025.

Retrospective Studies and Case Series

9. Mulvaney SW, Lynch JH, Curtis KE, Ibrahim TS. The Successful Use of Left-Sided Stellate Ganglion Block in Patients That Fail to Respond to Right-Sided Stellate Ganglion Block for PTSD. Military Medicine. 2022.
10. Lipov EG, Faber JA. Efficacy of Cervical Sympathetic Blockade in the Treatment of Primary and Secondary PTSD Symptoms: A Case Series. Heliyon. 2023.
11. Lipov E, Rolain H, Neufeld T. Treating PTSD in Canadian Special Operation Forces Command With Ketamine Plus Cervical Sympathetic Blockade. Military Medicine. 2025.
12. Sterling L, Fisher K, Woodbury A. Stellate Ganglion Block for PTSD and Chronic Low Back Pain: A Case Report of Three Veterans. Journal of Clinical Medicine. 2025.

Mechanistic Studies

13. Wang Z, Liu Z, Yu Y, et al. Stellate Ganglion Block Diminishes Consolidation of Conditioned Fear Memory in Mice by Inhibiting the Locus Coeruleus to the Basolateral Amygdala Neural Circuit. Translational Psychiatry. 2025.
14. Prasad S, Jain N, Umar TP, et al. Sympathetic Nerve Blocks for Posttraumatic Stress Disorder: An Evidentiary Review for Future Clinical Trials. Frontiers in Psychiatry. 2024.

Clinical Guidelines

15. Schnurr PP, Hamblen JL, Wolf J, et al. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of Internal Medicine. 2024.
16. Zoellner LA, Schulz PM, Campbell-Law L, et al. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025). American Psychological Association. 2025.
17. Sartor Z, Kelley L, Laschober R. Posttraumatic Stress Disorder: Evaluation and Treatment. American Family Physician. 2023.

This article was prepared by the PainSpa Clinical Team for educational purposes. It reflects the state of evidence at the time of writing and does not constitute individual medical advice. Clinical decisions should always be based on careful patient assessment, appropriate consent, and the experience of the treating clinician. SGB for PTSD remains an off-label treatment, but one with growing evidence and increasing clinical interest.

PainSpa © 2026