Post-COVID-19 condition, also known as long COVID-19 syndrome and post-acute sequelae of SARS-CoV-2, encompasses an array of symptoms that persist well beyond the initial phase of the viral infection. These symptoms can range in intensity, from mild and manageable to severe and incapacitating. Due to the evolving nature of the SARS-CoV-2 pandemic, treatment protocols for the illness are in a constant state of evolution. The early stage of long COVID-19 syndrome contributes to a dearth of treatment protocols based on empirical evidence, while the absence of a conclusive pathophysiological understanding further complicates the development of such protocols. Current treatment regimens include homeopathic medicine, specialist system-focused treatments, infusion therapies, hyperbaric oxygenation, antivirals, and polypharmacy. The physiological, psychological, and societal impact of long COVID-19 cannot be approached casually and must govern the intensity with which the healthcare community approaches the treatment of long COVID-19 syndrome.
In this 41-patient cohort study from a chronic pain management practice, the use of either unilateral or bilateral stellate ganglion block (SGB) was explored to manage symptoms associated with long COVID-19 syndrome. Results indicated that a substantial proportion of patients (86%) experienced a reduction of their symptoms following SGB treatment.
The pathophysiology behind long COVID-19 remains a topic of study, but evidence points toward the nervous system’s immunomodulatory activities playing a role in symptom manifestation. Several studies have shown links between long COVID-19 and an imbalanced immune response with persistent inflammation. Increased levels of cytokines such as interleukin (IL)-6, tumour necrosis factor-alpha (TNF-α), IL-1β, IL-8, and IL-10 suggest a sustained inflammatory state. The C-reactive protein, which indicates inflammation, is elevated in long COVID-19 patients. Its levels correlate with symptom severity and duration, but there is variability among individuals.
The symptoms most frequently reported by our patients were fatigue, observed in 85% of cases, and brain fog, present in 80% of individuals. These symptoms showed the highest response to treatment, with 77% of patients experiencing fatigue reporting significant relief, and 80% of those suffering from brain fog reporting relief. In our patient group, the loss of taste and smell proved to be the most challenging symptom to treat, with only 56% of patients reporting improvement. Although, we were able to obtain a higher response rate for anosmia with the addition of a trigeminal nerve block.
There was a marked statistical significance across all symptoms in response to SGB treatment, with p-values below 0.001 for most symptoms, demonstrating the broad effect of the treatment. The exception was “changes in menstruation,” for which the significance was still noteworthy with a p-value less than 0.05, in both one-sided and two-sided tests. This suggests a comprehensive impact of the SGB treatment across a range of symptoms.
The results of our cohort study indicate that SGB is a promising treatment option for patients suffering from long COVID-19 syndrome. The rapid resolution of symptoms and high success rate of treatment make SGB a compelling treatment option for long COVID-19 patients. However, it should be noted that our findings are limited to a specific subset of patients, and further research is needed to confirm these results. The use of ultrasound guidance and the specific anaesthetic used may also play a role in the efficacy of SGB, and further studies in these areas are warranted. While further double-blind placebo-controlled testing is necessary, the highly favourable patient response to this treatment suggests that it should not be withheld by healthcare providers. Despite the need for additional studies, we believe that this safe and effective procedure should be made broadly available to patients suffering from long COVID-19.
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At Pain Spa, Dr Krishna is highly experienced in performing Stellate Ganglion Blocks (SGB injections) under ultrasound guidance. Please contact us for further details if you are interested in having a consultation with Dr. Krishna.
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