Stellate Ganglion Block for Atypical Facial Pain: Dr. Chinmoy Roy | Faculty, Asian Pain Academy

Ultrasound Guided Stellate Ganglion Block

Introduction

Atypical facial pain (AFP), now classified as Persistent Idiopathic Facial Pain (PIFP) by the International Headache Society, is a chronic condition characterized by continuous, poorly localized facial pain without any identifiable structural or neurological cause [1]. It frequently resists conventional pharmacotherapy — including tricyclic antidepressants and anticonvulsants — and carries significant psychological burden [2]. Emerging evidence implicates sympathetic nervous system dysregulation in its pathogenesis, making the Stellate Ganglion Block (SGB) a rational and evidence-supported interventional strategy.

The Stellate Ganglion: Anatomy and Function

The stellate ganglion — the cervicothoracic sympathetic ganglion — is formed by fusion of the inferior cervical and first thoracic sympathetic ganglia, present in approximately 80% of individuals [3]. Located at the C7 level anterolateral to the longus colli muscle, it provides sympathetic innervation to the head, face, neck, and upper extremities [4]. Disruption of this pathway through SGB can reduce adrenergic stimulation of sensitized facial nociceptors and interrupt sympathetically maintained pain cycles [5].

Scientific Evidence for SGB in Atypical Facial Pain

Shanthanna (2013) reported a patient with severe, refractory AFP who achieved significant improvement in pain and functional disability lasting beyond 10 weeks following ultrasound-guided SGB, with subsequent blocks reinforcing analgesia [6]. Jeon and Kim (2015) demonstrated complete pain relief alongside thermographic normalization of facial skin temperature in an AFP patient with maxillary involvement — confirming the sympathetic vascular component [7]. Darabad et al. (2020) reported 40–100% pain relief for up to three months in cancer-related facial pain treated with SGB [8]. Jeon (2016), in a mini-review, confirmed that SGB is beneficial across orofacial pain disorders by modulating sympathetic outflow and reducing central sensitization [5].

Radiofrequency of the Stellate Ganglion

For patients who respond to SGB but require sustained relief, radiofrequency of the stellate ganglion offers a longer-lasting option. Luo et al. (2022) confirmed in a comprehensive review that Pulsed Radiofrequency (PRF) of the stellate ganglion provided up to 75% pain relief at six-week follow-up in refractory facial pain, and that radiofrequency treatment can significantly extend the remission period compared to local anesthetic blocks alone, without severe complications [9].

Technique and Safety — Dr. Roy's Live Demonstration

In this Asian Pain Academy module, Dr. Chinmoy Roy performs a real-time, ultrasound-guided SGB using an in-plane anterior approach at C7, with colour Doppler identification of the carotid artery and internal jugular vein, precise needle placement deep to the prevertebral fascia, and injection of 5–8 ml local anesthetic with confirmation by ipsilateral Horner's syndrome. Narouze (2014) established that ultrasound guidance significantly improves safety over the blind technique by preventing inadvertent intravascular injection [10]. Piraccini et al. (2023) in StatPearls outline key precautions: bilateral simultaneous SGB is contraindicated, and the commonest side effect — hoarseness — is transient [11].

Conclusion

Stellate ganglion block for atypical facial pain is an evidence-backed, minimally invasive intervention that deserves a prominent role in the pain physician's toolkit. When performed under ultrasound guidance by trained practitioners, SGB is both safe and effective — with radiofrequency of the stellate ganglion extending its therapeutic durability. The live demonstration by Dr. Chinmoy Roy at Asian Pain Academy equips clinicians with the anatomical knowledge, procedural technique, and clinical rationale to implement this intervention confidently.

Scientific References

1.      Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

2.      Madland G, Feinmann C. Chronic facial pain: a multidisciplinary problem. J Neurol Neurosurg Psychiatry. 2001;71(6):716–719. PMID: 11723191.

3.      Marchetti C, et al. Anatomy, Imaging, and Clinical Significance of the Cervicothoracic (Stellate) Ganglion. Diagnostics. 2025;15(22):2911. doi: 10.3390/diagnostics15222911.

4.      Mehrotra M, Reddy V, Singh P. Neuroanatomy, Stellate Ganglion. StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.

5.      Jeon Y. Therapeutic potential of stellate ganglion block in orofacial pain: a mini review. J Dent Anesth Pain Med. 2016;16(3):159–163. PMC5586552.

6.      Shanthanna H. Utility of stellate ganglion block in atypical facial pain: a case report and consideration of its possible mechanisms. Case Rep Med. 2013;2013:293826. PMC3770018.

7.      Jeon Y, Kim D. The effect of stellate ganglion block on the atypical facial pain. J Dent Anesth Pain Med. 2015;15(1):35–37. PMC5564068.

8.      Darabad RR, Kalangara JP, Woodbury A. Cancer-related facial pain treated with stellate ganglion block. Palliat Med Rep. 2020;1(1):290–295. PMC8241335.

9.      Luo Q, Wen S, Tan X, Yi X, Cao S. Stellate ganglion intervention for chronic pain: a review. iBrain. 2022;8(2):210–218. PMC10529017.

10.   Narouze S. Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep. 2014;18(6):424. PMID: 24760493.

11.   Piraccini E, Munakomi S, Chang KV. Stellate Ganglion Blocks. StatPearls. Updated 2023 Aug 13. NCBI Bookshelf: NBK507798.

https://www.youtube.com/watch?v=9wzR_AqJsJA