IMPACT OF STELLATE GANGLION BLOCK ON SYMPTOMS OF POST ACUTE SEQUELA OF COVID (PASC/LONG COVID): CASE SERIES FROM A TERTIARY PAIN CENTER

Introduction

Post Acute Sequelae of COVID (PASC), or Long COVID, often involves brain fog, fatigue and pain. It is highly prevalent (~50% of COVID infection), disabling, and difficult to treat. Preliminary evidence suggests possible efficacy of stellate ganglion block (SGB), though few studies used standardized measures. Here we present 3 cases of PASC treated by right SGB, where patient- reported outcomes were collected using validated instruments as part of standard clinical care. We hypothesize that SGB is effective in treating PASC, especially in the domains of pain interference and fatigue.

Methods

Three female patients, between 30 and 53, diagnosed with PASC and failed medical treatment, received a right SBG in 2023. Patient reported outcomes (PRO’s) assessing pain, mood, and function using NIH PROMIS and other instruments were collected before and after SGB. The change in each domain was computed as difference in T-score, and statistical significance estimated by paired T-test.

Results

Figure 1 summarizes outcomes to SGB for each case. Reduction is seen in most symptoms, including number of body areas with pain, pain interference, and Neuro-QoL Cognitive Function; and reached statistical significance in fatigue (p=0.008).

Conclusions

SGB was effective in reducing most symptoms, including pain interference and number of painful body areas. It was most effective in reducing fatigue, which is a key symptom in PASC and likely related to deranged neuro-immune axis, which can be modulated by SGB. Future studies should be performed in larger cohorts and extend to other post-viral syndromes with autonomic features (eg. fibromyalgia, chronic fatigue syndrome).