What primary care physicians should know about NSR treatment

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In my years of practice, I’ve come to appreciate that effective treatment goes beyond addressing symptoms. As a physician, my calling revolves around transforming lives. Neuro sympathetic reset (NSR) is one such transformative approach that’s redefining the space of both pain management and mental health treatment. With a foundation built on my training as a physiatrist and interventional pain management specialist at the University of Michigan in Ann Arbor, I’ve used a technique that’s long been recognized for its effective pain relief — the stellate ganglion block. It mainly addresses conditions such as anxiety, post-traumatic stress disorder (PTSD) and depression.

Michael Louwers, MD
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Despite the clear and science-backed benefits of NSR, there are still misconceptions, particularly among primary care physicians. To promote its broader adoption, let’s clear up the three biggest myths surrounding NSR and explore the truths that can help us better serve our patients.

3 biggest myths about NSR

Myth 1: NSR is a steroid or cortisone injection.

Many primary care physicians mistakenly categorize NSR as a steroid injection, equating it to the typical cortisone shots used for pain relief. The truth is that NSR involves a procedure that blocks certain nerves using ropivacaine, a long-acting local anesthetic, similar to novocaine used at the dentist’s office. Unlike steroids, which carry a host of potential side effects, ropivacaine does not have any lasting negative side effects. With the exception of a rare allergy to anesthetics, there are no contraindications for receiving NSR. For patients, this distinction is crucial, as it dispels fears of side effects associated with steroid injections.

Myth 2: NSR will change personality.

The concern that NSR alters a patient’s personality is another common misconception. NSR doesn’t change who you are; it changes how your nervous system reacts to stress and trauma. The procedure targets the body’s physiological fight-or-flight response, allowing patients to address their triggers with healthy coping strategies. This reset helps reduce a hyperactive nervous system’s automatic responses, such as heightened anxiety or stress. After undergoing NSR, many patients report improvements in mood, sleep and productivity, which enable them to be their best self, not a completely different person. Decision-making capacity and core personality traits remain untouched by the treatment.

Myth 3: NSR is similar to ECT.

NSR is often wrongly compared with electroconvulsive therapy (ECT), a treatment that involves electrical currents. However, NSR is entirely different. Our treatment is a straightforward, 20-minute procedure where the local anesthetic ropivacaine is injected into a group of nerves called the stellate ganglion and the sympathetic chain in the neck. This injection helps to calm an overactive fight-or-flight response. Although the anesthetic’s physical effects wear off in approximately six to eight hours, the mental health benefits — such as reduced anxiety, better sleep and diminished PTSD symptoms — can last for months and even years for some patients. NSR does not involve any electrical currents, and the process is much less invasive and more tolerable than ECT.

Understanding how NSR works

NSR is performed using ultrasound-guided injections of ropivacaine. The procedure typically begins with an injection on the right side of the neck, followed by a similar injection on the left side shortly thereafter. NSR helps reduce the overgrowth and overstimulation of nerves that occur after traumatic experiences. This alleviation of unhealthy brain connections can provide an “emotional reboot,” effectively resetting the sympathetic nervous system.

The impact of NSR

NSR often provides relief in as little as 10 minutes. It specifically diminishes the overactivity of the amygdala, the brain’s emotional center, also known as the “fear center.” This reduction in amygdala overdrive helps to alleviate symptoms of emotional trauma, including fear, anxiety, depression and hypervigilance, allowing patients to regain control over their lives.

From its roots in pain management, NSR has evolved into a versatile treatment option with applications beyond what was initially imagined. This includes treating mental health conditions as well as physical conditions such as chronic pain, menopause symptoms and even long COVID-19. NSR addresses the underlying physiological responses that perpetuate these symptoms by reversing the impact of trauma, offering patients a pathway to improved mental and physical health.

Why primary care physicians should consider NSR

For primary care physicians, it’s critical to understand that NSR can be the answer to improving patient care, particularly for those experiencing treatment-resistant conditions. Traditional approaches to treating PTSD, anxiety and depression often involve a combination of medication and therapy, which can be time-consuming and seldom practical. NSR is especially valuable for patients whose conditions haven’t responded well to conventional treatments or who prefer to avoid the side effects of psychiatric medications.

Since we opened our treatment center in June, I’ve already seen how NSR has changed so many lives. We have had patients who once felt trapped by their symptoms and found freedom and regained functionality. They reported improvements in sleep, mood and social interactions, which have made it easier for them to engage with life in more meaningful ways. For the medical community, it’s time to recognize the potential of NSR in opening doors to more holistic, effective treatments for conditions that have long been challenging to manage.

Michael Louwers, MD, is associate medical director at Reset Medical and Wellness Center in Strongsville, Ohio. A University of Michigan-trained physiatrist and interventional pain management specialist, he is double board certified with more than 15 years of experience. His practice spans the treatment of diverse pain conditions such as migraines, fibromyalgia, disc herniations, and scoliosis, and now focuses on mental health treatment.