Dual nerve block may ease treatment-resistant anxiety, study finds
A clinical trial at the Sri Madhusudan Sai Institute of Medical Sciences and Research in Chickballapur, near Bengaluru, found that a dual stellate ganglion block (SGB) may reduce symptoms in patients with treatment-resistant anxiety. Of 63 patients, 42 received the dual SGB and 21 a sham procedure, and were followed for 12 weeks. The SGB group showed significantly greater symptom reduction, said the team led by G. Niraj. Researchers said larger studies are needed to confirm the findings.
Source
The Hindu — National · read the original report ↗
Desk check · some claims need care
What the desk checked (5)
- Dual stellate ganglion block reduced anxiety symptoms significantly more than a sham procedure in 63 treatment-resistant patients. — Figures and outcome appear in the source, attributed to a trial published in Pain Physician (July-August 2026 issue).
- The trial is the world's first randomised controlled trial of dual SGB for treatment-resistant anxiety. — Source explicitly presents this as a claim by the researchers, not independently verified.
- 42 patients received dual SGB and 21 a sham procedure, followed for 12 weeks. — Numbers appear in the source; consistent with the stated total of 63.
- 14 patients had temporary hoarseness lasting one to three hours; one had upper-limb numbness resolving within six hours; no serious adverse events. — Safety figures stated in the source, attributed to the study.
- Findings need confirmation through larger studies as the trial was single-centre with 12-week follow-up. — Caveat attributed to the researchers in the source.
Analysts’ view opinion
Read as a clinical result, this is a modest but interesting signal: a single-centre randomised trial of 63 patients suggesting a nerve block may ease anxiety that has not responded to medication and therapy. Read as policy, it is a reminder of where India's mental health delivery gap actually sits — the researchers themselves frame the appeal as a short, clinic-based procedure in settings where sustained psychotherapy is hard to access. That framing is both the promise and the risk: procedures scale more easily than counselling capacity, which is precisely why the evidence bar and referral rules must be set before any wider adoption is considered.
- The trial's design strengths — randomisation and a sham comparison — matter more for policy credibility than the headline finding, since sham-controlled testing is what separates a genuine effect from expectation in symptom-based conditions.
- Scale and duration are the binding constraints for any policy use: 42 patients treated, 21 sham, one centre, 12 weeks of follow-up, with the authors themselves calling for larger studies.
- The entry criteria are unusually well specified for a niche intervention — failure of at least one first-line medication and one psychotherapy course of eight weeks each — and any future protocol would need to hold that gatekeeping line rather than let the procedure drift to first-line use.
- The lead researcher's own caution that this does not replace therapy or medication is the operative governance point; India's shortage of psychiatrists and psychologists creates a structural pull towards procedural substitution that guidelines, not intentions, have to resist.
- Safety in this trial looked manageable — no serious adverse events, temporary hoarseness in 14 patients, one case of transient limb numbness — but an ultrasound-guided injection in the neck presumes trained operators, which sits awkwardly with the rural access argument the researchers advance.
What to watch — Watch whether the finding is taken up for multi-centre replication with longer follow-up, and whether any professional body or public programme responds with referral criteria and operator-training norms rather than ad hoc adoption in private practice.
The story does not establish how long any benefit lasts, how the effect works, whether it holds outside this single private hospital, or that any regulator, insurer or public health programme has taken any view on the procedure.
Deep dive
Research brief · 8 facts · 3 dates · exam-readyThe brief
Context
Doctors at the Sri Madhusudan Sai Institute of Medical Sciences and Research (SMSIMSR), a private medical college hospital in Chickballapur near Bengaluru, ran a randomised controlled trial testing a dual stellate ganglion block (SGB) in patients with treatment-resistant anxiety — anxiety that persists despite standard drugs and psychotherapy. SGB involves injecting a local anaesthetic and steroid mixture, under ultrasound guidance, into a cluster of nerves in the neck that form part of the sympathetic nervous system controlling the "fight-or-flight" response. The team, led by anaesthesiology senior consultant G. Niraj, claims this is the world's first randomised controlled trial of dual SGB specifically for treatment-resistant anxiety. The results appear in the July-August 2026 issue of the open-access journal Pain Physician.
Key facts
- The trial enrolled 63 patients with moderate to severe treatment-resistant anxiety; 42 received dual SGB and 21 received a sham procedure.
- Patients were followed for 12 weeks; the SGB group showed a significantly greater reduction in anxiety symptoms than the sham group.
- The study was published in the July-August 2026 issue of Pain Physician, an open-access journal.
- The block was performed on both sides of the neck, with the second injection given between 24 hours and seven days after the first.
- 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.
- Forty-six of the 63 participants had already tried at least two medications.
- No adverse event in the SGB group was serious: 14 patients had temporary hoarseness lasting one to three hours, and one had upper-limb numbness that resolved within six hours.
- Limitations: single-centre trial with only 12 weeks of follow-up; durability of benefit and mechanism remain unclear.
Timeline
- Trial period (dates not stated in the source)63 patients with treatment-resistant anxiety randomised at SMSIMSR, Chickballapur; 42 given dual SGB, 21 sham, each followed for 12 weeks.
- July-August 2026Findings published in the open-access journal Pain Physician.
- September 15, 2026The study and its claim of being the world's first randomised controlled trial of dual SGB for treatment-resistant anxiety reported publicly.
Who has a stake
- Patients with treatment-resistant anxiety — A possible additional clinic-based option when first-line medication and psychotherapy have failed.
- Sri Madhusudan Sai Institute of Medical Sciences and Research (SMSIMSR), Chickballapur — Site of the single-centre trial; its claim to the first RCT of dual SGB for this indication.
- G. Niraj and the multidisciplinary team (pain medicine physicians, psychiatrists, clinical psychologists) — Authors of the trial; must validate findings through larger studies.
- Mental health services in rural and urban India — Researchers say a clinic-based intervention could help where access to long-term psychological therapy is limited.
- Pain Physician journal / research community — Publishing and scrutinising an early, single-centre finding needing replication.
Why it matters
Anxiety that does not respond to standard medication and therapy leaves patients with few options, especially where long-term psychological therapy is hard to access. A short, ultrasound-guided clinic procedure with no serious adverse events in this trial could widen the treatment menu, but the evidence is from a single centre with just 12 weeks of follow-up. The researchers themselves stress that SGB is an addition to, not a replacement for, medication and psychotherapy.
UPSC angle
Prelims pointers
- Stellate ganglion block (SGB): injection of local anaesthetic plus steroid into neck nerves of the sympathetic nervous system under ultrasound guidance.
- The sympathetic nervous system governs the body's 'fight-or-flight' stress response.
- Trial site: Sri Madhusudan Sai Institute of Medical Sciences and Research, Chickballapur, near Bengaluru; lead researcher G. Niraj.
- Design: 63 patients, 42 dual SGB vs 21 sham, 12-week follow-up; published in Pain Physician (July-August 2026).
- Treatment-resistant anxiety here means failure of at least one first-line drug and one first-line psychotherapy, each for at least eight weeks.
- Reported side effects: transient hoarseness in 14 patients (1-3 hours); one case of upper-limb numbness resolving within six hours.
Mains framing
Treatment-resistant anxiety — persisting despite at least one first-line medication and one first-line psychotherapy given for eight weeks each — represents a gap in India's mental healthcare, worsened where long-term psychological therapy is unavailable or unaffordable. The SMSIMSR trial tests a physiological rather than purely psychological route: dampening excessive sympathetic nervous system activity through a dual stellate ganglion block, on the reasoning that the body's stress alarm can remain "stuck in the on position." The results are encouraging on both efficacy (significantly greater symptom reduction than sham over 12 weeks) and safety (no serious adverse events; transient hoarseness in 14 patients), and the authors suggest a clinic-based procedure could extend care in rural and urban settings alike. Yet the caveats are structural: a single centre, 63 participants, a short 12-week window, and no clarity on how long benefits last or the exact mechanism at work. The way forward, as the researchers frame it, is multi-centre replication with longer follow-up, mechanistic study, and clear positioning of SGB as an adjunct to — not a substitute for — psychotherapy and pharmacotherapy, alongside continued investment in accessible mental health services.
Key terms
- Stellate ganglion block (SGB)
- Injection of a local anaesthetic and steroid mixture into a group of neck nerves under ultrasound guidance to reduce sympathetic nerve activity.
- Dual SGB
- The block performed on both sides of the neck, the second given between 24 hours and seven days after the first.
- Sham procedure
- A placebo-like mock intervention given to the control group (21 patients here) so results can be compared fairly.
- Treatment-resistant anxiety
- Anxiety that fails to respond to at least one first-line medication and one first-line psychotherapy, each for a minimum of eight weeks.
- Sympathetic nervous system
- The part of the nervous system driving the body's 'fight-or-flight' stress response.
- Randomised controlled trial (RCT)
- Study design where participants are randomly assigned to intervention or control, considered strong evidence for treatment effects.
Practice questions
- Discuss the potential and limitations of procedural interventions such as the stellate ganglion block in treating treatment-resistant anxiety, with reference to the recent Indian randomised controlled trial.
- Why is replication through larger, multi-centre studies with longer follow-up essential before a single-centre trial finding is adopted into clinical practice?
- How can clinic-based mental health interventions complement, rather than substitute for, psychotherapy and pharmacotherapy in settings where access to long-term therapy is limited?
Grounded only in the source report — figures and dates are the source's, not inferred.