Dual Nerve Block Procedure Shows Promise for Treatment-Resistant Anxiety

A clinical trial conducted by doctors at a private medical college hospital in Chickballapur, near Bengaluru, has found that a dual stellate ganglion block (SGB) procedure may help reduce anxiety symptoms in patients who do not respond to standard treatment. The study was published in the July-August 2026 issue of Pain Physician, an open-access journal.

The trial, described by the researchers as the world's first randomised controlled trial evaluating dual SGB specifically for treatment-resistant anxiety, involved 63 patients with moderate to severe symptoms. Of these, 42 received the dual SGB procedure and 21 received a sham treatment. Patients were followed for 12 weeks. Those who underwent the procedure showed a significantly greater reduction in anxiety symptoms than those in the sham group.

The research was led by G. Niraj, senior consultant in anaesthesiology, along with a multidisciplinary team of pain medicine physicians, psychiatrists, and clinical psychologists at the Sri Madhusudan Sai Institute of Medical Sciences and Research (SMSIMSR) in Chickballapur.

A stellate ganglion block involves injecting a local anaesthetic and steroid mixture into a group of nerves in the neck under ultrasound guidance. These nerves form part of the sympathetic nervous system, which governs the body's "fight-or-flight" response. In this trial, the procedure was performed on both sides of the neck, with the second block administered between 24 hours and seven days after the first. The researchers suggested that reducing excessive sympathetic nervous system activity may help ease some anxiety symptoms.

"Persistent anxiety is not just in the head. The body's stress alarm can remain stuck in the 'on' position. Our research helps to reset this stress response, offering hope to people whose anxiety has not responded to standard treatments," Dr. Niraj said. He emphasised that SGB is not intended to replace psychological therapy or medication, describing it instead as another valuable option for patients with poorly controlled anxiety.

The procedure was generally well tolerated. None of the adverse events reported in the SGB group were serious. Temporary hoarseness lasting one to three hours was reported by 14 patients, while one patient experienced numbness in an upper limb that resolved within six hours.

The study focused on patients whose anxiety had persisted despite standard treatment. Treatment-resistant anxiety was defined as failure to respond to at least one first-line medication and one first-line psychotherapy, each given for at least eight weeks. Most participants had tried several medications, with 46 of the 63 having tried at least two.

Dr. Niraj and his colleagues noted that the findings could have implications for mental healthcare in both rural and urban areas, particularly where access to long-term psychological therapy is limited. They suggested that a clinic-based intervention, used appropriately alongside existing mental health treatment, could offer a valuable option for patients with difficult-to-treat anxiety.

The researchers cautioned that the results need confirmation through larger studies. The trial was conducted at a single centre and followed patients for only 12 weeks. Further research is needed to determine how long the benefits last and to better understand the mechanism through which SGB may help reduce anxiety.