Dr. Deborah Duricka—affiliated assistant professor at the University of Alaska, researcher at Neuroversion, and Solve Ramsay Research Grant Awardee—continues to lead the way in understanding how we may treat people with Long Covid or ME/CFS by using stellate ganglion block. A stellate ganglion block involves injecting an anesthetic drug into the stellate ganglion nerves, which are in the front part of a person’s neck. The stellate ganglion regulates sympathetic signals, which control body functions that happen automatically (like blood pressure, heart rate, and sweat). Because Long Covid and ME/CFS often severely disrupt sympathetic functions, bringing about symptoms like orthostatic intolerance and poor sleep, stellate ganglion blocks may significantly help people with these diseases.
In earlier work, Dr. Duricka’s team at the Neuroversion pain-management clinic in Anchorage showed how stellate ganglion block indeed reduces symptoms in people with Long Covid. Within a few hours of having injections, people were less anxious, less depressed, less dizzy when standing, less fatigued, and had less post-exertional malaise (PEM). They also had better focus, better memory, better senses of taste and smell, and more regular heart rates. Incredibly, patients continued to do well long after getting a single injection. They reported feeling better for at least 30 days after treatment; and sometimes, for many months.
In this study, “Stellate Ganglion Block reduces symptoms of SARS-CoV-2-induced ME/CFS: A prospective cohort pilot study,” Dr. Duricka tested how much stellate ganglion block reduced symptoms in people who had both Long Covid and ME/CFS. Dr. Liu administered injections to ten adult patients each week for three weeks. (Interestingly, the team could tell at once that people were responding to the anesthetic because soon after injections, their faces would display tell-tale signs of the block—for example, their faces would become flushed or their eyes would droop.) Then, over the next two months, the team measured peoples’ cognition, orthostatic intolerance, physical functioning, sleep, social functioning, and vitality. Patients completed surveys and took online tests that measured cognitive and physical functioning, and they wore electronic sensor rings that tracked how well they slept. Patients also collected and returned samples of their spit for measuring how injections affected levels of cortisol (a hormone whose levels are characteristically low in people with Long Covid or ME/CFS and whose dysregulation can cause symptoms). And during in-person visits, the research team measured patients’ blood pressure, heart rate, and pulse to assess orthostatic intolerance during physical tests.
The team found that the stellate ganglion blocks significantly helped people with Long Covid and ME/CFS, just as it helped people with Long Covid in the earlier study. The injections improved cognition, physical and social functioning, and vitality. They also reduced orthostatic intolerance and POTS. However, the injections did not improve all symptoms; for example, patients’ cortisol levels did not significantly improve. And while patients reported that the injections helped them to feel significantly more refreshed after sleep, they also reported substantial problems remained; for example, problems with fragmented sleep and sleep apnea.
Still, these results suggest overall that stellate ganglion block significantly reduces sympathetic symptoms in people with Long Covid and ME/CFS. This is clearly important, since we have no approved way to treat people suffering from such symptoms. Dr. Duricka said, “The millions of individuals who suffer from ME/CFS are in urgent need of treatment options and hope. I am grateful to Solve M.E. for supporting this work with a Ramsay Research Grant. Without their help, this endeavor would not have been possible.”
Dr. Duricka’s team noted the important steps for developing stellate ganglion block as a treatment. For example, they recommended using more sophisticated tests to measure changes in symptoms, like the Tilt-Table Test to measure orthostatic intolerance (instead of the simpler 10-minute NASA Lean Test, which the team used here) and ultrasound tests to measure blood flow to the brain. Also, the team recommended testing treatments with many more patients. Given limited funds, the team could test the injections with only a few people (and could include no healthy participants, for comparing with patients). But, these exciting preliminary results are a strong foundation for more extensive clinical trials to evaluate stellate ganglion blocks as a treatment for people with Long Covid and ME/CFS.
Read “Stellate Ganglion Block reduces symptoms of SARS-CoV-2-induced ME/CFS: A prospective cohort pilot study” here.
