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Pain and Spine Medicine

Stellate Ganglion Block in the Treatment of Postural Orthostatic Tachycardia Syndrome (POTS): A Novel Use Case Report

Saturday, October 25, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 4

    Co-Author(s)

  • MS

    Michael Suarez, DO

    Resident Physician
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

  • SW

    Samantha Wu, MD

    Resident Physician
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

    • Primary Author(s)

  • Ahmed Khawer, DO

    Resident Physician
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

Disclosure(s):
Ahmed Khawer, DO: No financial relationships to disclose
Case Diagnosis: Postural Orthostatic Tachycardia Syndrome (POTS)

Case Description or Program Description: A 41-year-old female with a 10 year history of POTS presented to the interventional pain clinic. Her symptoms first began 5 years prior to her diagnosis, without a specific precipitating event. Her symptoms included fatigue, dizziness, nausea, IBS (multiple episodes of diarrhea per day), mental clouding, sporadic elevated HR ranging between 150-200 beats per minute, temperature dysregulation, and anxiety; inhibiting her ability to perform her activities of daily living (ADLs) or stand for more than 20 minutes. Previous treatment included an abdominal binder, metoprolol, duloxetine, amitriptyline, dextroamphetamine, low dose naltrexone, dietary changes and hydration, with minimal relief of symptoms. Given the failure of conservative management, the clinical team decided to pursue a left stellate ganglion block. The patient tolerated the procedure well with no complications.

Setting: Comprehensive pain management center

Assessment/Results: Two weeks post-procedure, the patient reported that she had significant symptomatic improvement, including total resolution of syncope and dizziness, the ability to stand for greater than 30 minutes, pulse in the normal range under 100 BPM, improved nausea, improved IBS symptoms, and resolution of hot flashes. She described her results as “life changing”, now with the ability to stand upright for more than 30 minutes without orthostatic symptoms for which she had not experienced in over 10 years.

Discussion (relevance): This is the first reported case, to our knowledge, of the successful use of a stellate ganglion block to aid in the treatment of POTS.

Conclusions: The application of a stellate ganglion block led to a remarkable reduction in the symptoms of POTS in this patient, showcasing its promise as a novel therapeutic strategy.