Considering SGB? A Doctor’s Guide to Neuro Sympathetic Reset for PTSD, Anxiety, and Stress: Who Is a Candidate, How It Works, and What to Expect

If you’re considering stellate ganglion block (SGB) for trauma, anxiety, or chronic stress, you’re likely asking the right questions:

Am I a candidate?

Will it work?

How long does it last?

Is it safe?

These are the same questions I walk through with patients every day. The goal of this guide is simple: help you make a confident, informed decision.

When I sit down with patients to discuss this treatment, I am not just explaining a procedure. I am helping them understand what is driving their symptoms and whether targeting the nervous system makes sense for them. What most people call a stellate ganglion block is a treatment of the sympathetic nervous system, the part of your body responsible for the fight-or-flight response. In many patients dealing with trauma, anxiety, or chronic stress, that system becomes overactive and remains that way. What I hear most often is not only emotional distress but also physical symptoms, including panic attacks, poor sleep, irritability, and a constant sense of being on edge. The goal is not to mask those symptoms but to address the source of the injury - the overactive response - so the body can begin to regulate again.

It is also important to clarify how we approach SGB at Reset. We do not offer just a standard stellate ganglion block. What we perform is called Neuro-Sympathetic Reset (NSR), our more advanced and refined approach designed to optimize outcomes. This includes dual-level targeting of the cervical sympathetic chain, a structured treatment process, and a strong emphasis on trauma-informed care and integration after the procedure. If you would like to learn more about this approach, you can visit:

https://www.theresetcenter.com/neuro-sympathetic-reset. The key point is that the procedure itself is only one part of the process. How it is performed, how patients are prepared, and how they are supported afterward all play a major role in outcomes.

One of the most important parts of my process is determining who is actually a good candidate. At Reset, I use a structured, objective intake process with validated clinical assessments for PTSD, anxiety, and depression. I encourage every patient to start with our free self-assessment here: https://www.theresetcenter.com/self-assessment. This allows us to measure your symptoms using tools like the PCL-5, PHQ-9, and GAD-7, giving both you and me a clearer understanding of what you are experiencing. At the same time, I always emphasize that numbers alone do not tell the full story. I have seen patients with lower trauma scores still benefit, particularly when their symptoms are more physical in nature. In those cases, the decision becomes more individualized, which is why we offer free consultations to review your specific situation and determine the best path forward.

Another question that commonly comes up is, “Will this help my other conditions?” Patients often ask whether this treatment can improve issues like chronic pain, POTS, autoimmune or inflammatory conditions, migraines, traumatic brain injury, gastrointestinal symptoms, or functional neurologic disorders. The answer is that these conditions can absolutely improve, but typically not because we are treating them directly. Instead, we are addressing the underlying nervous system dysregulation, including chronic stress, poor sleep, and persistent hyperarousal, all of which can significantly worsen these conditions. As the nervous system begins to regulate, I often see meaningful improvements in both symptom severity and frequency.

In addition, one of my research interests is understanding how the inflammatory system responds after sympathetic blockade and how this may directly influence certain conditions, particularly traumatic brain injury, neurologic disorders, and autoimmune disorders. I recently published a case report: https://www.theresetcenter.com/post/case-study-tbi-treatment

demonstrating improvement in post-concussive symptoms following this approach. However, it is important to be clear that Neuro Sympathetic Reset is not a direct treatment for these conditions, and the literature is still evolving. That said, we are seeing very encouraging clinical results, especially in conditions that are heavily influenced by stress and nervous system dysregulation.

Another consideration is "How long will the effects last?" The honest answer is that it varies. Some patients notice improvement within hours to days, while others experience a more gradual shift. Many patients will have meaningful relief lasting months to years, and some benefit from a repeat treatment. What I focus on most is not just duration, but opportunity. When the nervous system is no longer stuck in a constant fight-or-flight state, it creates a window in which real healing can take place.

Safety is understandably a major consideration for most patients. When performed with real-time ultrasound guidance and precise technique, this procedure is very safe. In my practice, I have extensive experience with cervical spine and ultrasound-guided interventions, and every step of the process is done with careful attention to detail, patient comfort, and safety. There are expected temporary effects such as a drooping eyelid, regional numbness, or mild hoarseness, all of which resolve within several hours. More serious complications are exceedingly rare. In my experience, patients consistently find the procedure to be much quicker, smoother, and more comfortable than they anticipated.

As I guide patients through this decision, I often come back to a few key questions:

• Do your symptoms feel like your body is stuck in overdrive?

• Have you tried traditional approaches but still feel limited by your symptoms?

• Do you want to stop masking your symptoms and start treating the underlying injury?

• Are you open to addressing the nervous system directly while also committing to the work that comes afterward?

If the answer is yes, then Neuro Sympathetic Reset may be a very reasonable option to consider.

What we are seeing in medicine right now is a shift. For years, trauma care has focused on coping. What we are now moving toward is addressing the underlying physiology. My goal is not just to help patients manage symptoms, but to help create a state where healing is actually possible. If you are considering this treatment, start with education, complete the assessment, and take the next step at your own pace.

• Michael Louwers, MD