The stellate ganglion is a bundle of sympathetic nerves at the base of your neck, part of your body's "fight or flight" system. Treating it aims to calm an overactive sympathetic nervous system, which can contribute to certain pain conditions and stress-related symptoms, though individual results vary. There are several treatment options, used only as far as needed:

• Local anaesthetic: numbs the area immediately, helping confirm the response.
• Pulsed radiofrequency (pulsed RF): short bursts of energy applied to the same nerves without destroying them, aiming for longer-lasting effect.

This procedure may help conditions such as complex regional pain syndrome (CRPS), certain head and face pain, and symptoms linked to an overactive stress response (e.g. sleep disturbance, hypervigilance). It is sometimes performed at two levels in the neck in the same session, as this may be more effective than a single level.

This procedure may help if you have:

• Pain or symptoms consistent with complex regional pain syndrome (CRPS) in an arm or hand
• Certain types of head, face, or upper limb pain
• Symptoms of an overactive stress response, such as persistent sleep disturbance, anxiety surges, or hypervigilance following extreme stress

It isn't possible to guarantee how any individual will respond. As a general guide:

• Local anaesthetic: works within minutes and wears off after a few hours.
• Pulsed RF: effect usually begins after a couple of weeks and may continue to improve over the following month or two; response is often assessed over a course of up to 3 visits.

This procedure is generally considered safe when performed under X-ray guidance, though as with any medical procedure benefit cannot be guaranteed and complications rarely occur. Pulsed RF modulates the nerve rather than destroying it.

Common, minor effects:

• Temporary hoarse voice, drooping eyelid, or dry eye on the treated side (Horner's syndrome) — usually resolves within 24 hours
• Temporary soreness at the injection site

Rare, more serious risks:

• Temporary difficulty swallowing
• Infection or bleeding at the injection site
• Nerve injury, damage to nearby structures (thyroid, major blood vessels, windpipe, food-pipe), which is rare with X-ray guidance
• Allergic reaction to the local anaesthetic or contrast dye
• Small increased lifetime risk from the X-ray (fluoroscopy) exposure used to guide the procedure
• Serious sedation or anaesthetic complications, very rarely including stroke or death
• Failure to respond, in which case the procedure may need to be repeated on the same or opposite side

• Tell us about any blood-thinning medication (e.g. warfarin, Xarelto, Plavix) well in advance — special arrangements may be needed and you may be asked to pause these under guidance
• Tell us if you are, or might be, pregnant — this procedure uses X-ray guidance
• Tell us about any allergies, including to contrast dye, local anaesthetics, or reactions to previous injections or anaesthesia
• You will usually be asked to fast for 6 hours beforehand if sedation is planned
• Bring a list of your current medications
• Arrange for someone to drive you home afterwards

• You will be positioned lying on your back (supine)
• The skin over the treatment area is cleaned with antiseptic
• Local anaesthetic numbs the skin before the main needle is placed
• Live X-ray (fluoroscopy) guides the needle precisely to each target
• The procedure usually takes less than 20 minutes

• You will be monitored briefly in recovery before going home
• Some soreness at the injection sites is common for 1-3 days — simple pain relief (e.g. paracetamol) usually helps
• You may remove the small dressing after 24 hours, keeping the area clean and dry
• Avoid strenuous activity or heavy lifting for 24-48 hours
• If you were sedated, avoid driving, operating machinery, or making important legal or financial decisions for 24 hours
• Continue your regular medications unless specifically advised otherwise

Contact your GP, Total Pain Clinic, or your nearest Emergency Department if you notice:

• Increasing redness, swelling, or discharge at the injection site
• Fever or feeling generally unwell
• New weakness, numbness, or loss of bladder/bowel control
• Severe pain not settling with simple pain relief

A review appointment is usually arranged 2-4 weeks after your procedure to discuss how you responded and plan next steps — please call Total Pain Clinic reception to schedule this if it hasn't already been arranged. Please ask your doctor any questions before you proceed; you will be asked to sign a consent form if you agree to go ahead.