An anesthetic injection reduces anxiety when medication and therapy fails
STUDY: Niraj G et al, Pain Physician 2026
STUDY TYPE: Randomized, double-blind, placebo-controlled trial
FUNDING: Sri Madhusudan Sai Institute of Medical Sciences & Research
Background
The stellate ganglion is a group of nerves in the neck that connects to brain regions that govern fear, including the amygdala. Blocking it with an anesthetic reduced anxiety in a few sham-controlled trials of PTSD and anxiety, particularly hyperarousal/sympathetic symptoms. This trial tested blocking both sides in treatment-resistant anxiety without PTSD.
The Study
- 63 adults in India with moderate to severe treatment-resistant anxiety (Anxiety GAD-7 score ≥10; most did not respond to 2+ meds).
- Randomized 2:1 to two ultrasound-guided nerve blocks, one per side, or sham saline injection, double-blind. Followed 12 weeks.
- Primary outcome: GAD-7 change at 4 weeks.
Results
Anxiety scores fell 9.6 points with the block versus 3.6 with sham, a gap that held through 12 weeks. At 4 weeks, 61% of the block group felt much or very much improved, versus 10% on sham. Most sham patients later asked for the real procedure, and 88% of crossovers reported real benefit.
Side Effects
Temporary hoarseness affected a third of the block group for a few hours.
No serious risks occurred, but its rare risks include seizures, collapsed lung (pneumothorax), bleeding, infection, and unintended nerve blocks. Ultrasound or X-ray guidance lowers these complication rates.
Limitations
Single-center, short follow-up. Only a third of patients had tried psychotherapy, so it’s not clear this was true treatment-resistance. The injection included a steroid, and it’s unclear how much that added.
Practice Implications
- There are close to zero evidence-based options for treatment-resistant anxiety, and these growing trials place stellate ganglion block as an option.
- It is offered by interventional pain management physicians, anesthesiologists, and some psychiatric care networks like Stella Mental Health. The procedure has risks, and reliable centers are skilled in ultrasound-guided neck injections; the needle sits near the carotid artery.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
