+100%-

A procedure developed in the 1930s that shoots anesthetics into big nerve bodies found on each side of the neck? Does that sound sketchy or what? It’s reported, though, to be quite safe and it aims to do two potentially important things in long COVID, fibromyalgia, chronic fatigue syndrome, and related diseases: calm down the sympathetic nervous system and restore blood flows. It’s called stellate ganglion block (SGB) and it was just tried in long COVID.

The goal was to block fight/flight signals to the brain – allowing the system to reset itself.

The “fight or flight” response driven by the sympathetic nervous system appears to be on high alert in chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), postural orthostatic tachycardia syndrome (POTS), and numerous inflammatory diseases. The corollary to that hyperactivation is an underactivation of the regulator of the sympathetic nervous system – the “rest and digest” or parasympathetic nervous system.

The potential ramifications of a chronically activated fight or flight response are many: impaired blood flows, inflammation, digestive problems, increased pain sensitivity, impaired viral defense, etc.

The Gist

  • It’s new to long COVID, and it’s new to ME/CFS, and it’s pretty new to fibromyalgia, but the procedure under discussion – called stellate ganglion block – is not new at all. It’s was developed in the 1930s.
  • The idea is simple – stun the nerve cell bodies that transmit sympathetic nervous system signals to the head and upper body – with an anesthetic – thus interrupting sympathetic nervous system (SNS) activity and producing an SNS reset which results in better blood flows. 
  • A chronically active SNS could reduce blood flows, increase inflammation, pain sensitivity, impair antiviral defenses, cause gut problems, and more.
  • The procedure is done on both sides of the neck over 2 days and takes about 30 minutes. It’s reportedly quite safe.
  • Doctors from a Neuroversion clinic in Anchorage, Alaska, reported that two long-term long COVID patients received substantial improvements from the injections. One woman, who had received “intensive physical, speech and occupational therapy” to cope with her debilitating cognitive and speech problems and fatigue, returned to work. Two months later she reported she was back to normal.
  • While no SGB studies have been done in ME/CFS a 1988 fibromyalgia study found that SGB produced significant reductions in pain.
  • SGB has been used to improve circulation in Raynaud’s phenomenon, reduce pain in chronic regional pain syndrome (CRPS), reduce phantom limb pain, and help with post-traumatic stress disorder (PTSD). It’s currently being trialed in post-menopausal syndrome, COVID-19, herpes zoster, severe brain injury, PTSD, and others.
  • Randomized, placebo-controlled trials are needed to assess whether SGB can be helpful in long-COVID and other diseases.
  • Once again, long-COVID has prompted investigations into treatment options that have been little or not tried at all in FM and ME/CFS.

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Blocking Sympathetic Nervous System Activity

Various drugs and mindfulness/meditation techniques have been used in an attempt to calm the fight or flight response down in these diseases. One intriguing technique, though, called stellate ganglion block (SGB) has almost never popped up in the ME/CFS, FM, or POTS medical literature. Demonstrating again, long COVID’s ability to shake things up and get investigators peering into all sorts of corners, it just showed up in a case series report for long COVID.

This old technique – developed in the 1930s – essentially jams a central waypoint for sympathetic nervous system activity called the stellate ganglion. These nerve bodies transport fight or flight messages to the upper spinal cord and brain. The technique consists of injecting an anesthetic near this big nerve body to temporarily block the fight or flight messages and hopefully reset the system.

One side of the neck is usually done in one day and the other side the other day. The procedure usually takes about 30 minutes after which the patient can return home. Different patients require different protocols. From 2 to 10 injections can be done, and the risks are described as “very low”.

The Stellate Ganglion Long-COVID Case Reports

This recent paper, “Stellate ganglion block reduces symptoms of Long COVID: A case series” – from two doctors associated with the Neuroversion clinic in Anchorage, Alaska – described two people with long COVID who received positive long-term results from this procedure. The clinic – whose motto is “Break the cycle of pain” – states its goal is “resetting the nerves rather than hiding the symptoms with opioids”.  It appears to specialize in injections and infusions of all kinds.

Patient Number One

Spinal nerve Sympathetic ganglion multilingual

Calming the sympathetic nerves leading to the neck and head – apparently increasing blood flows in the upper body – dramatically helped two people with long COVID.

Eight months after a relatively mild COVID-19 infection, a 42-year-old female experienced smell and taste problems, severe fatigue, cognitive problems, sleep difficulty, elevated heart rate, and other symptoms. She lost her full-time job and was struggling to keep up with a part-time job.

Her symptoms improved immediately after the block: smell and taste were restored, she was quickly able to drive again, her cognition dramatically improved, and she resumed longer working hours. Two months later her improvements remained.

Patient Number Two

Like patient number one, patient number two experienced a relatively mild case of COVID-19. Like patient one, though, she experienced severe cognitive difficulties and underwent “intense, occupational, physical, and speech” therapy for her “profound memory deficits”, her speech impediments, her inability to concentrate, coordination problems, and extreme fatigue. She also experienced significant body pain, headaches, and reported that mental or physical exertion would cause her symptoms to flare up.

Showing up at the Neurovision clinic about seven months after coming down with COVID-19, the second patient received the same set of injections on the right and left sides of her neck. Like the first patient, her taste and smell issues quickly disappeared. One week after the treatment she began teaching again. Two months later she reported she was back to normal – her fatigue and cognitive problems and PEM had all disappeared.

Other Diseases

Stellate ganglion blocks have been used to improve blood flows in Raynaud’s phenomenon, reduce pain in chronic regional pain syndrome (CRPS), reduce phantom limb pain, and help with post-traumatic stress disorder (PTSD). It’s currently being trialed in post-menopausal syndrome, COVID-19, herpes zoster, severe brain injury, PTSD, and others.

A recent review of stellate ganglion block studies focused on reducing sympathetic nervous system-driven pain disorders (which may include fibromyalgia) reported that the pain reduction achieved was “highly significant” and that the procedure was “safe and effective”.

Turning Stress into Pain: A Fibromyalgia Primer by Dr. Martinez-Lavin Pt I – Pain

Effects on Circulation

Increased sympathetic nervous system activity is believed to reduce blood flows by clamping down on the blood vessels. SGB’s ability to increase blood flows is well documented. Given all the interest in the microcirculation in ME/CFS, FM, and long COVID, it was eye-opening to see a 1988 fibromyalgia stellate ganglion block study “Regional sympathetic blockade in primary fibromyalgia” that attributed its positive results to improvements in the microcirculation. This study concluded, rather presciently, that increased sympathetic nervous system activity may contribute to fibromyalgia.

While SGB has not been studied in ME/CFS was featured prominently in a part of the discussion section focused on brain blood flows. Noting the Van Campen/Visser/Rowe ME/CFS findings of reduced blood flows to the brain, the authors reported that SGB has been shown to increase brain blood flows as well.

The Reduced Brain Blood Flow Diseases? Long COVID, ME/CFS and POTS

Just what exactly, happening, though, is unclear as the effects of SGB tend to last much longer than would be expected from the short-term use of this drug. The authors list three possibilities:

  1. a recalibration of regional sympathetic influence;
  2. central (brain) integration of the effects of increased CBF;
  3. rebalancing how the nervous and immune systems interact with each other.

Conclusion

Another long-COVID study has opened – or in the case of fibromyalgia reopened – a treatment possibility for diseases like ME/CFS, fibromyalgia, and one might guess POTS. The combination of a procedure that reduces sympathetic nervous activity (which we know is high), and has been shown to improve the circulation (apparently impaired to both the muscles and brain), is intriguing.

Whether doctors will want to try this approach is unclear, but the fact that a fibromyalgia study was done may help. Clinical studies report that the procedure is safe and takes about 30 minutes.

Until large, randomized, placebo-controlled trials are done, though, there’s no way to tell how representative these two successful case reports are. Doctors typically write case reports to get their findings into the medical literature and provide a basis for clinical trials. With an old but successful fibromyalgia clinical trial, and now these two cases reports, this procedure will hopefully get more study.

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I don’t know if you’ve ever heard of stellate ganglion blocks. I hardly had. Health Rising, though, keeps a close eye on the research literature, and when this report popped up, we checked it out only to find that this procedure may present a possible treatment option for these diseases.

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