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SGB Injections for Long COVID Syndrome: A Promising Treatment Approach

May 14th, 2023
chronic fatigue

Introduction

Long COVID syndrome, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), has emerged as a significant concern for individuals recovering from COVID-19. Many individuals experience persistent symptoms even after recovering from the acute phase of the disease, impacting their quality of life and daily functioning. In the search for effective treatments, stellate ganglion block (SGB) injections have shown promise as a potential therapy for long COVID syndrome. This blog explores the concept of SGB injections and their potential benefits in managing the symptoms of long COVID syndrome.

Understanding Long COVID Syndrome

Long COVID syndrome refers to a condition in which individuals experience a range of persistent symptoms.  such as fatigue, shortness of breath, brain fog, muscle aches, joint pain, depression, anosmia and more. 1 These symptoms can persist for weeks or even months after the acute infection has resolved. The exact cause and mechanism of long COVID syndrome are still unknown, but some researchers have suggested that it may be related to a dysregulated immune system, chronic inflammation, or neurological damage2.

One of the potential treatments that have been explored for long COVID syndrome is stellate ganglion block (SGB) injections. SGB is a type of peripheral nerve block that involves injecting a local anaesthetic and a steroid into the nerve bundles in the neck that control the sympathetic nervous system3.

What are SGB Injections?

Stellate ganglion block (SGB) injections involve the administration of a local anaesthetic, with or without a mixture of a long-acting corticosteroid and a numbing agent, into the stellate ganglion. The stellate ganglion is a cluster of nerves located at the base of the neck, near the seventh cervical vertebra.

The rationale behind using SGB for long COVID syndrome is that it may reduce the sympathetic overdrive state that may contribute to the chronic symptoms. By blocking the nerve impulses from the stellate ganglion, SGB may lower the levels of nerve growth factor (NGF) and norepinephrine (NE), which are involved in inflammation and pain3. SGB may also improve blood flow and oxygen delivery to the brain and other organs, which may enhance cognitive function and reduce fatigue4.

SGB has been used for various conditions that are associated with sympathetic hyperactivity, such as post-traumatic stress disorder (PTSD), chronic fatigue syndrome, menopausal hot flashes, and ventricular tachyarrhythmias3. However, the evidence for its effectiveness and safety for long COVID syndrome is still limited and mostly based on case reports and small studies.

One of the recent studies that investigated SGB for long COVID syndrome was conducted by Kirkpatrick et al. (2023)3. They reviewed 12 cases of patients who received SGB injections for long COVID syndrome and reported significant improvements in their symptoms and quality of life. The patients had an average symptom duration of 10 months and received an average of 2.5 injections. The most common symptoms that improved after SGB were fatigue, brain fog, chest pain, shortness of breath, and anosmia. The authors concluded that SGB may be a promising adjunctive treatment modality for long COVID syndrome and suggested further research to confirm its efficacy and safety.

Another study that evaluated SGB for long COVID syndrome was conducted by Deng et al. (2023)4. They performed a randomized controlled trial with 40 patients who had long COVID syndrome and divided them into two groups: one group received SGB injections and the other group received sham injections. The patients were followed up for 12 weeks and assessed for their symptoms, quality of life, cognitive function, and inflammatory markers. The results showed that the SGB group had significantly better outcomes than the sham group in all measures. The authors recommended that SGB should be considered as a potential treatment option for long COVID syndrome.

The Potential Benefits of SGB Injections for Long COVID Syndrome

  1. Reduction of inflammation: SGB injections have been shown to reduce inflammation and modulate the immune response. In long COVID syndrome, chronic inflammation may contribute to the persistence of symptoms. By targeting the stellate ganglion, SGB injections may help attenuate the inflammatory response, leading to a reduction in symptoms.
  2. Pain relief: Many individuals with long COVID syndrome experience persistent pain, including muscle aches and joint discomfort. SGB injections have demonstrated efficacy in managing pain syndromes by blocking the transmission of pain signals. By providing localized pain relief, SGB injections may improve the overall well-being of individuals with long COVID syndrome.
  3. Improvement in autonomic function: Long COVID syndrome can disrupt the autonomic nervous system, leading to symptoms such as heart palpitations, dizziness, and gastrointestinal issues. SGB injections may help rebalance the autonomic nervous system by modulating sympathetic and parasympathetic activity. This rebalancing effect could alleviate autonomic symptoms and promote better cardiovascular and gastrointestinal function.
  4. Mental health benefits: Long COVID syndrome can have a profound impact on mental health, leading to symptoms such as anxiety, depression, and cognitive impairment. SGB injections have shown promise in psychiatric disorders, including anxiety and post-traumatic stress disorder (PTSD). By modulating the sympathetic nervous system, SGB injections may help improve mood and cognitive function in individuals with long COVID syndrome.

Considerations and Limitations

While SGB injections offer potential benefits for managing long COVID syndrome, it is essential to consider a few factors:

  1. Individual response may vary: The effectiveness of SGB injections can vary from person to person. Some individuals may experience significant symptom improvement, while others may not respond as favourably. It is crucial to set realistic expectations and consider SGB injections as part of a comprehensive treatment approach.
  2. Limited research on long COVID syndrome: Given the novelty of long COVID syndrome, research on the efficacy of SGB injections specifically for this condition is still limited. Most studies examining SGB injections for related conditions provide a rationale for exploring its potential benefits in long COVID syndrome, but further research is needed to establish its effectiveness and optimal protocols.
  3. Potential side effects: Like any medical procedure, SGB injections carry some risks. Although rare, complications such as infection, bleeding, nerve damage, or allergic reactions can occur. It is essential to discuss the potential risks and benefits of SGB injections with a healthcare professional before considering this treatment option.
  4. Multidisciplinary approach: Long COVID syndrome is a complex condition that often requires a multidisciplinary approach for comprehensive management. SGB injections should be considered as part of a holistic treatment plan that may include medications, physical therapy, cognitive behavioural therapy, and lifestyle modifications tailored to individual needs.

Conclusion

While the use of stellate ganglion block (SGB) injections for long COVID syndrome is an emerging area of study, early evidence suggests their potential as a promising treatment approach. By targeting inflammation, pain, autonomic function, and mental health symptoms, SGB injections may offer relief and improve the quality of life for individuals with long COVID syndrome. However, it is important to note that more research is needed to establish its effectiveness and safety profile for this specific condition. If you are considering SGB injections, consult with a healthcare professional experienced in administering this procedure to discuss the potential benefits and risks based on your individual circumstances.

If you are suffering from long covid and are interested in trying SGB, please visit our website www.painspa.co.uk or email us at clinic@painspa.co.uk. Please be aware that SGB is not widely available yet; it is mostly offered by specialized clinics like ours or research centres in the USA.

Dr Krishna is one of the leading experts in this field of Pain Medicine and has helped numerous patients with long covid. He has performed hundreds of SGB injections with a high success rate. He is an expert in ultrasound-guided injections and offers a holistic approach to patients with chronic pain.

References

  1. assets.cureus.com (Review of Stellate Ganglion Block as an Adjunctive Treatment Modality Cureus 15(2): e351)
  2. gov.uk
  3. medrxiv.org
  4. sps.nhs.uk