Long Covid – How a Treatment for Chronic Pain Is Helping Patients with Long Covid
– Cervical sympathetic ganglion blocks (SGB) have historically been used to diagnose and treat complex regional pain syndromes (CRPS) of the upper extremities. This technique is utilized when increased perfusion to the head and upper extremity is needed, oftentimes this is in patients suffering from complex regional pain syndrome or reflex sympathetic dystrophy.
This blockade of sympathetic tone has led to improvement of blood flow to the affected extremity as well as improvements in pain. The cervical sympathetic trunk is a confluence of the 3 main ganglia, or nerve cell bodies, the cervical, stellate, and upper thoracic ganglion providing sympathetic outflow to the head and upper extremities.
Injection of local anesthetic over the cervical sympathetic ganglion has been done since the 1930s to achieve sympathetic denervation to the head, neck, and upper limbs as well as the lacrimal, salivary, and thyroid glands. This has become a mainstay of treatment for sympathetic mediated pain syndromes including CRPS.
Over the years, this treatment modality has experienced an expansion in utilization for varied pathologies. Stellate ganglion blocks are now widely considered in the treatment algorithm for PTSD, through its neuromodulating effects on the amygdala, SGB has shown to have efficacy in individuals with chronic sympathetic over activation, demonstrable in people who suffer from PTSD.
Similarly, the benefits of sympathetic denervation have been examined in individuals suffering from Long Covid. A study by Liu and Duricka, published in the journal of neuroimmunology, examines the efficacy of stellate ganglion blocks for symptoms of Long Covid.
A significant portion of individuals testing positive for Covid-19, both symptomatic and asymptomatic develop a syndrome now commonly described as long covid. Incidences of any of the “Long Covid-19” features have been reported from 46.42% in the 10-21 age group and 61.05% in the over 65 age group. Among those admitted to the ICU the incidence of Long covid symptoms has been as high as 73.22%.
Some of the most common symptoms, pathognomonic, for Long covid include; memory or concentration problems, mental fatigue, anxiety, and depression. 2 patients, ages 42 and 44 with an average of 8 months duration of symptoms after acute covid infection were treated with stellate ganglion blocks and followed. Both patients demonstrated an immediate improvement in mental concentration, clarity, and mood. Symptoms of anosmia and dysgeusia were also subjectively improved. Ultimately these 2 patients were able to return to their previous level of functioning with notable improvement in their quality of life. These effects were durable at 60-day follow-up as well.
This study suggests that sympathetically-mediated processes are involved in the syndromic appearance in Long Covid patients. The authors concluded that the application of stellate ganglion blockade for the treatment of Long Covid is novel but promising. These responses warrant further investigation, possibly giving hope to people suffering from Long Covid.
Reference sources:
Chauhan G, Upadhyay A, Khanduja S, et al. (August 08, 2022) Stellate Ganglion Block for Anosmia and Dysgeusia Due to Long COVID. Cureus 14(8): e27779. doi:10.7759/cureus.27779
https://www.cureus.com/articles/106516-stellate-ganglion-block-for-anosmia-and-dysgeusia-due-to-long-covid#:~:text=Stellate%20ganglion%20block%20(SGB)%20can,patient%20after%20she%20underwent%20SGB
Stellate ganglion block reduces symptoms of Long COVID: A case series.
https://pubmed.ncbi.nlm.nih.gov/34922127/
Liu LD, Duricka DL., J Neuroimmunol. 2022 Jan 15;362:577784. doi: 10.1016/j.jneuroim.2021.577784. Epub 2021 Dec 8., PMID: 34922127
https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
https://commons.wikimedia.org/wiki/File:Long-term_effects_of_COVID-19.webp
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