Liu, Luke D, Duricka, Deborah L · Journal of neuroimmunology · 2022 · DOI
This small study looked at a procedure called a stellate ganglion block, which uses local anesthetic to temporarily quiet the nerve signals in the neck that control your 'fight or flight' response. Two Long COVID patients received this procedure, and their symptoms—including fatigue, brain fog, and dizziness upon standing—improved. The authors suggest that an imbalance in the autonomic nervous system (the system that controls automatic body functions) may be contributing to Long COVID symptoms.
This study offers a potential explanation for why some ME/CFS and Long COVID patients experience unexplained fatigue, cognitive dysfunction, and orthostatic intolerance by implicating dysautonomia. If autonomic dysfunction is confirmed as a mechanism in larger, controlled studies, it could open new therapeutic avenues for patients whose conditions have been difficult to treat. The hypothesis connecting inflammatory cytokine responses to autonomic imbalance aligns with ongoing ME/CFS research into neuroimmune dysfunction.
This case series does not establish that stellate ganglion block is an effective or safe treatment for Long COVID; two cases cannot demonstrate efficacy. It does not prove that dysautonomia is the primary cause of Long COVID—only that autonomic dysfunction may play a role. Symptom improvement in two patients could reflect placebo effect, natural recovery, or other unmeasured factors, and lacks objective biomarkers or long-term outcome data.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Liu, Luke D & Duricka, Deborah L (2022). Stellate ganglion block reduces symptoms of Long COVID: A case series.. Journal of neuroimmunology. https://doi.org/10.1016/j.jneuroim.2021.577784
BibTeX
@article{mecfsatlas-liu-2022-stellate-ganglion,
author = {Liu, Luke D and Duricka, Deborah L},
title = {Stellate ganglion block reduces symptoms of Long COVID: A case series.},
journal = {Journal of neuroimmunology},
year = {2022},
doi = {10.1016/j.jneuroim.2021.577784},
note = {PubMed: 34922127},
url = {https://www.mecfsatlas.com/evidence/liu-2022-stellate-ganglion},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/liu-2022-stellate-ganglion
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