An estimated 17 million U.S. adults were living with Long COVID as of March 2024, according to KFF analysis of CDC Household Pulse Survey data — and the CDC’s 2023 Behavioral Risk Factor Surveillance System found that 6.4% of noninstitutionalized adults nationwide were experiencing Long COVID when surveyed. For many of these patients, standard treatments have provided little relief from debilitating symptoms like brain fog, fatigue, dizziness, and chronic pain. Now, a growing body of research is pointing to an unexpected solution: the stellate ganglion block (SGB), a nerve block procedure that pain management specialists have performed for nearly a century. In a 41-patient cohort study published in Cureus in 2023, 86% of Long COVID patients experienced symptom reduction following SGB treatment. At Arizona Pain and Spine Institute in Mesa — which already offers both stellate ganglion block and dedicated Long COVID treatment — Dr. Asim Khan and Dr. Daniel Ryklin are positioned to bring this emerging approach to patients across the East Valley.

Why Long COVID Symptoms Persist — The Autonomic Dysfunction Connection

Long COVID — formally known as post-acute sequelae of SARS-CoV-2 (PASC) — encompasses a wide range of symptoms that persist three or more months after the initial COVID-19 infection. The CDC has codified it into the International Classification of Diseases (ICD-10-CM), recognizing it as a distinct clinical entity. The most commonly reported symptoms include fatigue, brain fog (cognitive impairment), dizziness, headache, sleep disturbances, chronic pain, anxiety, and depression.

What makes Long COVID particularly challenging to treat is that conventional approaches — targeting individual symptoms with separate medications — often provide limited relief. A growing body of research suggests this is because many Long COVID symptoms share a common root: autonomic nervous system dysfunction.

A 2024 pilot study published in Psychopharmacology Bulletin by Levey et al. at the University of Texas Health Sciences Center found that 94% of their Long COVID patients reported moderate-to-severe autonomic dysfunction as measured by the COMPASS-31 scale (a validated tool for assessing autonomic symptoms). A 2025 scoping review published in Clinical Autonomic Research (Treadwell et al.) specifically examined treatments for Long COVID autonomic dysfunction, identifying SGB as one of several interventions targeting this mechanism. And a 2024 review in Nature Reviews Cardiology (Fedorowski et al.) described cardiovascular autonomic dysfunction as a major health-care burden in post-COVID syndrome.

The autonomic nervous system — including the sympathetic (“fight-or-flight”) and parasympathetic (“rest-and-digest”) branches — controls functions like heart rate, blood pressure, digestion, and body temperature regulation. When SARS-CoV-2 infection disrupts this system, patients can experience a cascade of seemingly unrelated symptoms that are actually connected through a common pathway of sympathetic hyperactivation. This is the same mechanism implicated in PTSD — which is why the stellate ganglion block, already demonstrated to help PTSD patients, is now being investigated for Long COVID.

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The Research: Four Studies Show Promising Results

Study 1: 41-Patient Cohort — 86% Symptom Reduction (Cureus, 2023)

The largest published study of SGB for Long COVID was conducted by Pearson et al. at a chronic pain management practice in Colorado. Published in Cureus in 2023, the study treated 41 self-referred patients with Long COVID symptoms lasting 3 to 29 months using ultrasound-guided unilateral or bilateral stellate ganglion block. The key finding was that 86% of patients experienced a reduction in their symptoms following SGB treatment. The study concluded that SGB “warrants further investigation as a potential treatment modality for Long COVID.”

Study 2: 52-Patient Boston Retrospective — Brain Fog, Fatigue, Dizziness Improved (Cureus, 2025)

A 2025 retrospective cohort study by Chiang et al. at a single institution in Boston analyzed 52 patients with PASC who received SGB between September 2022 and September 2024. Patients underwent an average of three SGB injections. The study found that most patients reported improvement in PASC symptoms after treatment, with the most commonly improved symptoms being brain fog, fatigue, dizziness, and headache.

Study 3: 17-Patient Pilot — 94% Had Autonomic Dysfunction, All Improved (Psychopharmacology Bulletin, 2024)

Levey et al. at the University of Texas Health Sciences Center conducted a pilot study of 17 Long COVID patients who underwent SGB. Among the findings: 94% of patients reported moderate-to-severe autonomic dysfunction before the procedure (confirming the autonomic mechanism), all patients reported some degree of symptomatic improvement, patients had significantly lower fatigue severity scores after treatment, and resting heart rates decreased significantly — an objective marker of reduced sympathetic hyperactivation.

Study 4: Retrospective Chart Review — Striking Reductions Across Multiple Symptoms (Autonomic Neuroscience, 2024)

Duricka and Liu published a retrospective chart review in Autonomic Neuroscience (2024) following up on their initial case series in the Journal of Neuroimmunology (2022). After one month or more following SGB treatment, patients reported substantial reductions in fatigue, worsening of symptoms following mental and physical activity, memory problems, difficulty concentrating, sleep problems, anxiety, and depression. The same research team subsequently published a 2025 prospective pilot study in Fatigue: Biomedicine, Health & Behavior showing that SGB significantly improved measures of post-exertional malaise, unrefreshing sleep, cognitive impairment, and orthostatic intolerance in patients meeting criteria for both Long COVID and ME/CFS.

Why This Makes Sense — The PTSD-Long COVID Connection

The application of SGB to Long COVID is not arbitrary. It’s grounded in a shared neurobiological mechanism. As Arizona Pain and Spine Institute patients may know from the practice’s work with PTSD and anxiety, the stellate ganglion — a cluster of sympathetic nerves at the base of the neck near the C6 and C7 vertebrae — regulates the body’s fight-or-flight response.

In PTSD, this system becomes chronically overactivated. In Long COVID, research suggests a strikingly similar pattern of sympathetic hyperactivation. The Levey et al. pilot study documented this directly: 94% of Long COVID patients showed measurable autonomic dysfunction. By temporarily blocking sympathetic nerve signaling at the stellate ganglion, SGB appears to allow the autonomic nervous system to recalibrate — potentially explaining why such a diverse array of symptoms (brain fog, fatigue, dizziness, pain, sleep disruption) can improve from a single intervention.

This shared mechanism is precisely why Arizona Pain and Spine Institute is uniquely positioned for this application. The practice already performs SGB routinely for PTSD and anxiety, and Dr. Khan has been specifically praised by patients for his SGB technique — one patient testimonial on the practice’s website states they travel from California specifically for Dr. Khan’s SGB injections.

How Arizona Pain and Spine Institute Approaches Long COVID With SGB

Infographic showing Long COVID symptoms like brain fog fatigue and dizziness connected to autonomic dysfunction and SGB treatment

Arizona Pain and Spine Institute’s existing infrastructure — both the SGB treatment capability and the dedicated Long COVID conditions program — positions the practice to offer this emerging treatment at their Mesa and Queen Creek locations.

The Evaluation

Long COVID patients begin with the practice’s comprehensive initial evaluation (typically 60+ minutes). The evaluation assesses the full spectrum of symptoms, medical history, prior COVID-19 infection timeline, and previous treatments attempted. Dr. Khan and Dr. Ryklin evaluate whether the patient’s symptom pattern is consistent with autonomic dysfunction — the mechanism that SGB targets.

The Procedure

The SGB procedure for Long COVID follows the same evidence-based protocol used for PTSD: an ultrasound- or fluoroscopy-guided injection of local anesthetic near the stellate ganglion at the C6 vertebral level. The procedure takes 5 to 15 minutes. Based on the published research, treatment may involve one to three sessions — the 52-patient Boston study found that patients underwent an average of three SGB injections. Temporary Horner’s syndrome (eyelid drooping) on the injected side confirms successful nerve block placement and resolves within hours.

The Multimodal Context

As the practice’s Long COVID conditions page describes, treatment plans are typically determined on an individual basis and may include physical therapy, rehabilitation, and medications. SGB is not intended as a standalone cure but as one component of a comprehensive approach — targeting the autonomic dysfunction that may be driving multiple symptoms simultaneously. The practice’s FastTrack cash-pay program is available for patients who need expedited access.

What Patients Should Realistically Expect — And Important Limitations

What the Evidence Supports

Across four published studies, SGB for Long COVID has shown:

  • 86% symptom reduction rate in the largest cohort (41 patients, Cureus 2023)
  • Improvement in brain fog, fatigue, dizziness, and headache as the most commonly responsive symptoms (52 patients, Cureus 2025)
  • Objective improvement in heart rate and fatigue severity scores (17 patients, Psychopharmacology Bulletin 2024)
  • Sustained reductions in fatigue, cognitive symptoms, sleep problems, anxiety, and depression at one month+ follow-up (Autonomic Neuroscience 2024)

Critical Limitations to Understand

Patients considering SGB for Long COVID should understand several important points. The evidence is still emerging — all published studies to date are retrospective cohort studies, chart reviews, or small pilot studies. No large-scale randomized controlled trial of SGB for Long COVID has been completed yet (although the shared mechanism with PTSD — where a Level 1B RCT does exist — provides supporting rationale). Study sizes range from 10 to 52 patients, meaning results should be interpreted with appropriate caution. Not all symptoms respond equally — the 2024 pilot study found that while fatigue and heart rate improved significantly, PTSD symptom reductions (PCL-5 scores) were clinically meaningful but did not reach statistical significance. SGB is not a cure for Long COVID. It is an emerging interventional option that appears to help a substantial proportion of patients but may not work for everyone. Arizona Pain and Spine Institute’s individualized evaluation process helps patients understand whether they are appropriate candidates based on their specific symptom profile.

Who Should Consider SGB for Long COVID

Based on the published research and Arizona Pain and Spine Institute’s approach, SGB for Long COVID may be most appropriate for patients who:

  • Have been diagnosed with Long COVID (symptoms persisting 3+ months after confirmed COVID-19 infection)
  • Experience symptoms consistent with autonomic dysfunction — particularly brain fog, fatigue, dizziness, headache, sleep disruption, or chronic pain
  • Have not found adequate relief from standard Long COVID treatments
  • Understand that this is an emerging application supported by promising but still-developing evidence
  • Are willing to participate in a comprehensive treatment plan that may include complementary approaches

The first step is a consultation. Contact Arizona Pain and Spine Institute at (480) 986-7246 or visit gotpainarizona.com. The FastTrack program provides expedited appointments for patients who cannot wait for standard scheduling.

Conclusion

With an estimated 17 million Americans living with Long COVID and limited effective treatments available, the emerging research on stellate ganglion block offers a meaningful new direction — one grounded in the same autonomic nervous system mechanism that has been validated in the PTSD literature. The 86% symptom improvement rate in the largest published cohort, combined with the Boston 52-patient study’s documentation of brain fog, fatigue, and dizziness improvement, and the objective autonomic markers from the University of Texas pilot study, collectively suggest that SGB deserves serious consideration for Long COVID patients who have not found relief elsewhere.

Arizona Pain and Spine Institute’s combination of established SGB expertise, a dedicated Long COVID program, and an individualized multimodal approach positions the practice to deliver this emerging treatment to patients across Mesa, Gilbert, Queen Creek, Chandler, Scottsdale, and Tempe. Call (480) 986-7246 or schedule through gotpainarizona.com.

Frequently Asked Questions

1. Can stellate ganglion block help with Long COVID brain fog?

The 2025 Boston retrospective study of 52 patients found that brain fog was among the most commonly improved symptoms following SGB treatment. The 2024 Autonomic Neuroscience chart review also documented reductions in memory problems and difficulty concentrating after SGB.

2. How many SGB treatments are needed for Long COVID?

The 52-patient Boston study found patients underwent an average of three SGB injections. Treatment frequency is individualized — Dr. Khan and Dr. Ryklin assess each patient’s response before recommending additional sessions.

3. Is SGB for Long COVID FDA-approved?

SGB and the local anesthetics used are FDA-approved for regional anesthesia. The application for Long COVID is “off-label” — supported by published research but not yet specifically FDA-indicated for PASC. This is common with emerging treatments.

4. How quickly do Long COVID patients notice improvement after SGB?

The 2024 pilot study documented significantly lower fatigue scores and heart rates shortly after the procedure. The Autonomic Neuroscience chart review measured sustained improvements at one month or more following treatment.

5. Does Arizona Pain and Spine Institute treat Long COVID?

Yes. The practice has a dedicated Long COVID conditions page and offers multiple treatment approaches. SGB is one component of an individualized treatment plan. Contact (480) 986-7246 for a consultation.

Disclaimer: This article references publicly available information from Arizona Pain and Spine Institute (gotpainarizona.com), Cureus (Pearson et al., 2023; Chiang et al., 2025), Psychopharmacology Bulletin (Levey et al., 2024), Autonomic Neuroscience (Duricka and Liu, 2024), Fatigue: Biomedicine, Health & Behavior (Duricka and Liu, 2025), Journal of Neuroimmunology (Liu and Duricka, 2022), Nature Reviews Cardiology (Fedorowski et al., 2024), Clinical Autonomic Research (Treadwell et al., 2025), CDC BRFSS 2023, CDC MMWR 2024, and KFF analysis of CDC Household Pulse Survey data, including peer-reviewed studies, government surveillance data, and published practice information dated 2022–2025. All metrics and study findings are from documented sources. Stellate ganglion block for Long COVID is an emerging application with promising but preliminary evidence; no large-scale randomized controlled trial has been completed for this specific indication. Published studies range from 10 to 52 patients. Results described are specific to the study populations mentioned and may vary based on individual circumstances, symptom severity, and treatment adherence. For current information about treatments offered at Arizona Pain and Spine Institute, consult gotpainarizona.com or call (480) 986-7246.