PAIN+ CPN

BACKGROUND: Anxiety disorders are associated with a high burden of illness. In patients with treatment-resistant anxiety disorder, management options can be limited. Stellate ganglion block has been reported to reduce anxiety symptoms in Posttraumatic Stress Disorder.

OBJECTIVES: We aimed to determine dual stellate ganglion block's effectiveness for reducing anxiety symptoms in moderate to severe treatment-resistant anxiety disorder.

STUDY DESIGN: This double blinded, sham procedure, randomized controlled trial used a 2:1 active treatment to sham (control) treatment ratio.

SETTING: Pain Medicine clinic at Sri Madhusudan Sai Institute of Medical Sciences & Research, a tertiary care medical college in the Republic of India.

METHODS: Study patients were screened by an interdisciplinary team comprising a pain medicine physician, a psychiatrist, and a clinical psychologist. Participants and assessors were blinded. Adult patients with treatment-resistant moderate to severe anxiety disorder (a Generalized Anxiety Disorder-7 [GAD-7] scale score of = 10) were included in the study. Patients with Posttraumatic Stress Disorder were excluded. Patients received either dual ultrasound-guided stellate ganglion blocks or a sham treatment.

RESULTS: The primary outcome measure was the GAD-7 scale score at postintervention week 4. Of 87 screened individuals, 63 were eligible (72.4%); 20 were men and 43 were women; mean (SD) age, 38.4 (10.3) years. They were randomized (42 to the Stellate Ganglion Blocks Group and 21 to the Control (Sham) Group; 62 (98.4%) completed the study. In an intent-to-treat analysis, the mean total GAD-7 score change at postintervention week 4 was -9.6 points for the Stellate Ganglion Blocks Group, compared with -3.6 points for those receiving the sham/control treatment (mean difference -6.2; 95% CI,-9.3 to -3.2; P < 0.001).

LIMITATIONS: This was a single-center study with a limited follow-up period.

CONCLUSION: In this trial of patients with treatment-resistant anxiety disorder, dual stellate ganglion blocks were effective in reducing GAD-7 scores for 12 weeks postintervention. Further studies are recommended to assess the durability beyond 12 weeks and elucidate the mechanism of action of stellate ganglion block.

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