Study finds dual nerve blocks procedure may help people with treatment-resistant anxiety

A clinical trial 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, published in the July-August 2026 issue of Pain Physician, an open-access journal, involved 63 patients with moderate to severe treatment-resistant anxiety. The researchers found that those who underwent the procedure had a significantly greater reduction in anxiety symptoms than those who received a sham procedure.

First randomised trial

Led by G. Niraj, senior consultant, anaesthesiology, and 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, the trial is claimed by the researchers to be the world’s first randomised controlled trial evaluating dual SGB specifically for treatment-resistant anxiety. 

The study involved 63 patients, of whom 42 received the dual SGB procedure and 21 received the sham treatment. The patients were followed for 12 weeks. 

What is the procedure? 

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 are part of the sympathetic nervous system, which controls the body’s “fight-or-flight” response. 

The procedure was performed on both sides of the neck, with the second block given between 24 hours and seven days after the first. The researchers said that reducing excessive activity in the sympathetic nervous system may help ease some symptoms of anxiety. 

“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 stressed that SGB was not intended to replace psychological therapy or medication. “It provides another valuable option for patients with poorly controlled anxiety,” he said.

Few serious side effects

The procedure was generally well tolerated by the patients in the study. None of the adverse events reported in the SGB group was 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 patients in the study had tried several medications. Forty-six of the 63 participants had tried at least two medications. 

Potential for wider mental healthcare 

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

More research needed 

The researchers cautioned that the findings need to be confirmed 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.