Long COVID or Post Covid-19 Condition is defined by the World Health Organization (WHO) as a condition “in individuals with a history of probable or confirmed SARS CoV-2 [COVID-19] infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction [brain fog] but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.” Some of the other troubling symptoms that we have been seeing include smell and taste disturbances, muscle aches, extremity pain, anxiety, depression and Postural Orthostatic Tachycardia Syndrome (POTS).
It looks like many of the Long COVID symptoms that people experience are a result of nerve damage and effects of inflammation (a normal healing process gone overboard) from the Spike Protein of the COVID-19 virus. The sympathetic nervous system that many people know as being responsible for the “fight or flight response” plays a part in producing some of the inflammatory substances (cytokines) that cause this damage. These sympathetic nerves pass through an area in the neck called the stellate ganglion.
With injection of local anesthetics in this region (Stellate Ganglion Block or SGB) we can block the sympathetic response. This helps restore a balance in the nervous system with some effects seen immediately, allowing an appropriate healing process to begin. In some patients a single SGB may be all that it takes. On others, such as those with severe or long-standing symptoms, we may need to repeat it, possibly in a small series. I follow my patients progress closely and may recommend a period of medications that help with nerve healing along with some supplements that have some real scientific evidence. While it’s a new application for Long COVID, the Stellate Ganglion Block was first performed over a hundred years ago and we have come a long way since. It is very minimally invasive procedure but is technically demanding. To provide the level of safety that has been experienced over the past couple decades, it should only be performed by board certified, fellowship trained interventional pain physicians, anesthesiologists, in a facility prepared to care for these patients. We have been using it with excellent success for other uses such as the treatment of CRPS (Complex Regional Pain Syndrome) and PTSD (Post Traumatic Stress Disorder). The rationale for using it for parosmia in Long COVID comes from a 2013 study by Korean scientists found that patients had improvement in olfactory dysfunction with SGB. It can be beneficial for many of the other symptoms of Long COVID that result from disruption of the sympathetic or autonomic nervous system.
It only takes a few minutes but preparation and observation after takes a little longer. An IV will be started to give some light sedation to relax you and appropriate monitoring will be done of your vital signs. After the skin is numbed up on the front side of your neck, I use a combination of ultrasound and fluoroscopy, an X-ray video, to guide the procedural needle to the Stellate Ganglion where a local anesthetic is injected.
World Health Organization: A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO/2019-nCoV/Post_COVID-19_condition/Clinical_case_definition/2021.1
Theoharides, T. Could SARS-CoV-2 Spike Protein Be Responsible for Long-COVID Syndrome? Molecular Neurobiology (2022) 59:1850–1861
Moon, H. Long-term Results of Stellate Ganglion Block in Patients with Olfactory Dysfunction. Korean J Pain. 2013 Jan;26(1):57-61.
Kerzner, J, et al. Stellate Ganglion Block for Psychiatric Disorders: A Systematic Review of the Clinical Research Landscape. Chronic Stress (2021) Jan-Dec; 5: 24705470211055176