How Much Does SGB Actually Help with POTS?

If you have POTS — Postural Orthostatic Tachycardia Syndrome — you already know that “how are you feeling?” is a complicated question. Is it the exercise intolerance today, or the fatigue? The nausea, or the brain fog? POTS doesn’t pick one symptom and stick with it. It shows up everywhere at once, which is part of why it’s so exhausting to live with and so hard to treat.

We’ve been offering Stellate Ganglion Block (SGB) for POTS patients for a while now, and patients ask me some version of the same question almost every week: does this actually work, and for which symptoms? So instead of relying on impressions from the exam room, I pulled the data from our own patient registry over the past two years and ran the numbers.

Here’s what we found.

The Setup

We looked at 51 patients who completed the Malmö POTS Symptom Scale (MAPS) — a validated, patient-reported questionnaire covering 12 core POTS symptoms, each scored 0 to 10 — both before treatment and again at one month. That gave us a clean before-and-after comparison, not just a gut feeling.

The Headline Result

On average, total MAPS scores dropped by 20.5 points (from a baseline average of 56.7 down to 35.9). That’s a statistically significant change (p < 0.001), and the effect size — Cohen’s d of 0.84 — falls in the “large effect” range by research standards. In plain terms: this isn’t noise.

Looking at it from the patient’s side of the table: 78% of patients improved. Among those who improved, the average drop was 28.4 points — essentially cutting their symptom burden in half. A smaller group, about 1 in 5, got slightly worse with an increase in symptoms of about 10 points, and that’s worth being upfront about. SGB isn’t a guarantee for everyone, and we don’t pretend otherwise.

In other words, when weighing the potential gain versus potential loss if you have POTS and are considering SGB, 3 out of 4 people seem to cut their symptoms in half, and 1 out of 4 people seem to experience a slight increase in symptoms.

Which Symptoms Improved Most?

This was the part I found most interesting. All 12 MAPS symptoms improved on average — not just one or two. But the symptoms that moved the most were:

• Exercise intolerance (the single biggest improvement)
• Fatigue
• Nausea
• Chest pain
• Tremor/shakiness and shortness of breath

These also happen to be the symptoms patients most often describe as the ones that wreck their day — the ones that keep someone from walking the dog, getting through a workday, or trusting their own body. That the largest gains landed on the highest-burden symptoms is, clinically, a meaningful pattern. It lines up with how SGB works: by calming an overactive sympathetic nervous system, which is the system driving a lot of POTS’ chaos in the first place — heart rate swings, GI symptoms, temperature regulation, the whole list.

Does It Matter What Caused Your POTS?

A lot of our patients developed POTS after a COVID infection. We wanted to know if that group responded differently than patients whose POTS had other triggers. The answer: not really. COVID-triggered POTS (d = 0.85) and non-COVID POTS (d = 0.84) showed essentially identical response patterns. Whatever set off the dysautonomia, SGB’s effect on the nervous system didn’t seem to care.

What About Men vs. Women?

Both groups improved. Women showed a numerically larger average response than men, though our male sample (12 patients) was small enough that we can’t draw firm conclusions from that gap — it could narrow with more data. What we can say confidently is that men in our data improved too, just with more variability.

The Honest Caveats

I want to be straight about the limitations here, because data without context can be misleading:

• This is open-label, observational data from our own clinic — there’s no untreated comparison group, so we can’t fully separate the effect of SGB from natural symptom fluctuation over time.
• These are the 51 patients who completed one-month follow-up out of a larger group; patients who didn’t return for follow-up aren’t reflected here.
• This snapshot covers one month. We don’t yet have longer-term data from this analysis to say how durable the improvement is.

We’re sharing this not because it’s a perfect controlled trial — it isn’t — but because it’s real-world data from real patients from all over the country who traveled to our clinic in Gambrills, Maryland, and we think people considering SGB for POTS deserve to see it.

The Bottom Line

For those of you suffering with POTS, you know the challenges of finding effective treatment options. In my experience POTS can be one of the most debilitating conditions and frustrating because it’s “invisible” to others. Living with POTS is extremely difficult for many. I know.

POTS is a multi-system condition, and in our data, SGB produced a multi-system response — broad improvement across exercise tolerance, fatigue, GI symptoms, and more, not just one isolated symptom. For the majority of patients in our registry, that translated into a real, measurable reduction in how much POTS was ruining their life.

If you’re living with POTS and wondering whether SGB might be worth a conversation, we’re happy to walk through where you stand and whether this approach makes sense for your specific symptoms.

Just call us. We’d be thrilled to help.

Calm the body. Calm the mind.