If you have been exploring Reddit threads about stellate ganglion block for Long COVID, you have seen the whole range of comments. People saying it gave them their life back. People who paid thousands and felt better for three weeks. People calling the whole thing a scam built on studies funded by the clinics.
Those are all real reactions, and they deserve real answers, not marketing.
In this post, we want to work through the most common questions, including the uncomfortable ones. Where the honest answer is “we do not know yet.”
Short version: a stellate ganglion block (or SGB) helps a meaningful share of Long COVID patients, especially those whose symptoms come from a dysregulated autonomic nervous system like POTS. The relief is sometimes durable and sometimes temporary, repeat injections are common, and the evidence is promising but not yet proven by a controlled trial. This makes SGB a reasonable option for the right patient, not a guaranteed fix.
Does it actually work, or is it placebo?
It works for some people, the effect is real enough to keep appearing across separate studies, and yes, placebo cannot be fully ruled out. Both things are true. The most cited study (Pearson, 2023, 41 patients) found 86% improved on at least one symptom. A more cautious 2025 study from Brigham and Women’s Hospital (52 patients) found 56% improved but only about 14% had lasting relief. A 2026 systematic review of seven studies found improvement across all of them and singled out patients with autonomic dysfunction as the best responders.
The honest caveat is none of those Long COVID studies had a control group, and the one randomized trial in this space, a sham-controlled test of SGB for COVID smell distortion, found it no better than placebo. So the skeptics are not wrong to want better evidence. The fair read is SGB has a genuine signal in autonomic-driven Long COVID and a thin evidence base. SGB is a reasonable option for the right patient, not a sure thing for everyone.
How long does it last, and will I need repeat injections?
With the procedure, the numbing wears off in hours. The benefit, when it holds, can last weeks, months or longer. But durability is the weak spot. In the 2025 cohort, patients averaged about three injections, and many people describe improvement fading, then needing a booster. Relapse most often follows a clear trigger like stress, another infection or surgery, because the body tends to drift back toward its old pattern.
So plan for the possibility of more than one. A repeat block is simply how the treatment reinforces the new autonomic balance for a lot of patients, not a failure. If you have had several with no real change, that is a different signal, and it usually means your symptoms were not autonomic in the first place.
It is expensive and insurance won’t cover it. Is it worth it?
SGB for Long COVID is generally considered off-label, meaning this use is not FDA approved, so it is often not covered by insurance and usually paid out of pocket. Costs vary by provider, so confirm the specifics directly. The most important way to protect your money is to confirm you are a likely responder before you book, not to negotiate the price.
The biggest predictor of whether SGB helps is whether your symptoms are driven by a dysregulated autonomic nervous system. A patient with clear post-COVID POTS, palpitations and a wired-but-tired pattern is a different candidate from someone whose main problem is, say, gut-driven fatigue. Paying for a proper evaluation first, so you know which mechanism is driving your case, is what keeps you from spending on a procedure unlikely to reach your problem.
What are the side effects? Should I be scared of the drooping eye?
The most visible effect is expected and harmless. Within minutes of a good block you could get a droopy eyelid, a smaller pupil, a red eye, a stuffy nostril and flushing on the treated side. This is called Horner’s syndrome, and it is neither a stroke nor a complication but it is the proof the block worked, and it wears off with the anesthetic. You could also potentially have a lump-in-the-throat feeling, hoarseness or mild trouble swallowing for a few hours, from the anesthetic briefly reaching a nearby voice-box nerve.
The serious risks of any neck injection, things like bleeding, nerve injury or a collapsed lung, are real but uncommon, and ultrasound guidance reduces your risk, keeping the vital structures visible the whole time. Across thousands of stellate ganglion blocks in his career, Dr. Groysman has not encountered those serious complications in his clinic. If you take blood thinners or platelet blockers like Eliquis or Coumadin, tell the clinic, because those may need to be paused beforehand.
I mainly have POTS. Does it work differently for autonomic symptoms versus smell loss?
The evidence does seem to split that way. The strongest case for SGB is in autonomic symptoms, the POTS-type racing heart, dizziness, palpitations, brain fog and the anxiety riding along with a sympathetic system in overdrive. The 2026 systematic review specifically pointed to autonomic dysfunction as the best-responding group. That is the mechanism the block targets.
Look for symptoms like, hyperadrenergic POTS or inappropriate sinus tachycardia (IST), a system stuck in fight or flight, coat hanger pain across the neck and shoulders, hypervigilance, sensitivity to sound and light, tinnitus, internal vibrations, adrenaline dumps and the wired-but-tired feeling peaking at night. If several of those describe you, you could be the kind of patient the autonomic evidence is talking about.
Smell and taste are more mixed. The one randomized trial, aimed at exactly that symptom, was negative. So if your single biggest complaint is distorted smell, go in with measured expectations and ask your provider directly about the gap. If your problem is autonomic, you are in the group the evidence supports most. You can read more on the dedicated SGB for POTS page.
I also have MCAS. Will SGB help that part?
Probably not directly. Mast cell activation is a different mechanism from autonomic dysregulation, and a sympathetic block targets the autonomic side. Many Long COVID patients have more than one mechanism running at once, which is exactly why a single treatment rarely fixes everything. SGB may help your autonomic symptoms while your mast cell symptoms need a separate approach. A good plan treats each driver on its own terms rather than hoping one procedure covers them all.
How do I find a provider who actually knows how to do this for Long COVID?
This is the most important practical question, because results depend heavily on technique and experience. A standard SGB done for pain is not the same procedure as the one used for Long COVID. Ask any provider these questions before you book:
- Do you use ultrasound guidance? Ultrasound lets the doctor see and avoid arteries, veins and nerves in real time, safer than going by X-ray landmarks alone.
- Do you block one level or two per side? Dual-level technique, reaching higher than the standard single level, has been associated with better recoveries.
- How many of these have you done, and how many in the last month?
- What do you do if I do not develop a good Horner’s syndrome?
- What kind of results have you had specifically for brain fog, anxiety or autonomic symptoms?
If a provider cannot or will not answer those, keep looking. A clinic doing this routinely will welcome the questions. They are also the questions Dr. Groysman can answer for any patient, and the standards behind his ultrasound-guided technique.
Honestly, aren’t all these studies run by clinics profiting from SGB?
It is a fair criticism, and largely accurate for the open-label Long COVID studies, which is why this page keeps pointing to their limits. The most cited study is the clearest example which is where the Pearson authors published a correction disclosing their affiliation with the clinic where the procedures were done. The full walk-through, including the one negative randomized trial, is in what the research actually shows post. The counterweight is SGB is not a fringe idea propped up only by interested clinics.
The core autonomic effect of SGB was demonstrated in an independent, randomized, sham-controlled trial in JAMA Psychiatry, for PTSD, in active-duty service members. That is the rigorous evidence making the Long COVID extension plausible.
On the related criticism that providers tout numbers without sharing data, the way to handle that is to lean on the published literature, not private tallies. Dr. Groysman is candid his own clinic observations are observations, not peer-reviewed results, and presents them as such.
This includes his safety record because a clinician’s count of his own complications is an observation, not a study, which is why the published risk literature is cited alongside it. The figures worth weighing are the published ones, with their sample sizes and their missing control groups visible, so you can judge them yourself. Transparency is the point. A treatment defending itself only with unverifiable in-house statistics is not one you should trust.
So what is the bottom line?
Stellate ganglion block is a plausible, mechanism-based treatment with a real but early evidence base. It helps a meaningful share of patients whose Long COVID runs through the autonomic nervous system, it sometimes needs repeating, it does fit into a larger protocol when symptoms are driven by more than one mechanisms, and it carries low risk in experienced hands. Not a miracle, and not a scam either. For the right patient, it is a reasonable option worth a serious conversation.
Request a consultation with Dr. Groysman
Learn more on the main stellate ganglion block page, read what the research shows, or see what a successful block looks like.