As a multiple-boarded clinician specializing in integrative psychiatric, cellular, and regenerative medicine, as well as neurologic rehabilitation at my practice, Neuregen in Scottsdale, Arizona, I’ve witnessed firsthand the toll Long Covid takes on patients. Long Covid, or Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), manifests with a wide variety of symptoms that can persist for months or even years after the initial infection. As the research evolves, one fact has become increasingly clear: Long Covid often disproportionately affects the brain and nervous system, creating challenges that require nuanced and comprehensive care (Taquet et al., 2021).
Long Covid Symptoms by body region
(Davis et al., 2023):
Above: Long COVID can affect multiple systems of the body, in varying combinations. It is thought that Long Covid is likely a condition caused by multiple, overlapping, causes potentially including reservoirs of SARS-CoV-2 in tissues, immune system dysregulation, reactivation of pre-existing pathogens (e.g., Epstein–Barr virus (EBV) and human herpesvirus 6), microvascular blood clotting with endothelial dysfunction; and dysfunctional signalling in the brain and nervous system (Davis et al., 2023).
Cardiovascular:
Chest pain
Palpitations
Cardiac impairment
Myocardial inflammation
POTS
Brain and Nervous System:
Cognitive impairment
Fatigue
Disordered sleep
Memory loss
Tinnitus
Dysautonomia
Myalgic encephalomyelitis/chronic fatigue syndrome
Neuroinflammation
Reduced cerebral blood flow
Small fiber neuropathy
Reproductive System:
Erectile dysfunction
Increased severity and number of premenstrual symptoms
Irregular menstruation
Reduced sperm count
Gastrointestinal tract:
Abdominal pain
Nausea
Gut dysbiosis
Viral persistence and viral reservoir
Immune system:
• Autoimmunity
• MCAS
Organs:
• Organ injury
• Diabetes
• Pancreas injury
Blood Vessels
• Fatigue
• Coagulopathy
• Deep vein thrombosis
• Endothelial dysfunction
• Microangiopathy
• Microclots
• Pulmonary embolism
• Stroke
The Neurologic and Multisystem Impact of Long Covid
Current estimates suggest that up to 30% of individuals who recover from COVID-19 experience Long Covid symptoms, with many reporting significant neurologic issues such as brain fog, memory disturbances, fatigue, and persistent headaches (Davis et al., 2021). Other studies highlight dysautonomia—disruption of the autonomic nervous system—which can lead to symptoms like erratic heart rates, blood pressure instability, and gastrointestinal dysfunction (Raj et al., 2021). This leaves a huge population of people tormented by "mystery symptoms".
However, Long Covid’s reach isn’t confined to the brain. The condition can affect multiple systems in the body, including the cardiovascular, pulmonary, immune, and endocrine systems. For example, chronic inflammation, endothelial damage, and immune dysregulation are all suspected contributors to the cascade of symptoms many patients face (Sivan & Taylor, 2020).
A Targeted, Neuro-Centric Approach to Diagnosis and Treatment
At Neuregen, my starting point is always a thorough examination of the nervous system. In patients with Long Covid, this often reveals multiple sites of injury or dysfunction—patterns that help guide our therapeutic approach. Addressing Long Covid requires precision, as every patient’s constellation of symptoms is unique. Once the dysfunctional areas are identified, I work with my patients to implement specific therapies designed to restore nervous system health and support overall recovery.
The therapies I offer include one or a combination of:
Neuromodulation Therapies: Techniques such as vagus nerve stimulation (VNS) and low level laser therapy (LLLT) help re-establish balance in neural circuits and promote recovery in the autonomic and central nervous systems (Groiss et al., 2021).
Regenerative and Cellular Therapies: Platelet-rich plasma (PRP) or stem cell therapies have shown promise in regenerating damaged tissues and reducing inflammation, although the research in this area is still emerging (Leng & Kang, 2020).
Stellate Ganglion Block (SGB): SGB, an injection of anesthetic near the stellate ganglion in the neck, has demonstrated utility in alleviating dysautonomia and symptoms like chronic fatigue, anxiety, and PTSD-like symptoms often seen in Long Covid patients (Linz et al., 2021).
Ketamine Therapy: Ketamine’s neuroplasticity-promoting effects have been beneficial in treating depression, anxiety, and chronic pain, which are common in Long Covid. Early studies suggest it may also support broader neuroregeneration (Feder et al., 2021).
Medical Hypnotherapy: Hypnosis can help patients manage chronic pain, fatigue, and anxiety by retraining the brain’s response to these stressors, empowering patients with greater self-regulation (Elkins et al., 2013).
Evidence and a Responsible Disclaimer
While there is no doubt that Long Covid is real, and while these therapies show promise, it is important to emphasize that the evidence supporting their use in Long Covid remains early and evolving - COVID just hasn't been around that long so medical learning and treatment of these conditions is adapting all the time. Research into neuromodulation therapies has highlighted their potential for improving brain function, with several studies supporting their use for conditions like depression and PTSD (Groiss et al., 2021). Similarly, stellate ganglion block has been studied for its effects on the sympathetic nervous system and autonomic dysfunction, with encouraging results in Long Covid case studies (Linz et al., 2021). Ketamine’s role in neuroplasticity and regenerative medicine’s application in immune modulation and tissue repair are supported by emerging data but require further validation (Feder et al., 2021; Leng & Kang, 2020).
However, many suffering people simply can't wait years for the body of clinical research to mature on long covid. It's probably a good idea that patients and clinicians approach these interventions with an open but cautious mindset, understanding that Long Covid is a relatively recent phenomenon in medical history, and ongoing studies are vital to refining and expanding our treatment strategies. That said, I have personally witnessed many patients recover function and hope following rational, innovative treatment approaches for Long Covid, including at our own clinic.
Hope Through Innovation
The journey with Long Covid is often frustrating, but it is not without hope. At Neuregen, my mission is to help patients reclaim their lives by targeting the root causes of their symptoms and fostering healing through an integrative and personalized approach. While there are no guarantees, I believe the strides we are making in adapting psychiatric, neurorehabilitative, and regenerative medical procedures to meet the current demands for treatment for long covid, are in some way contributing to meaningful recovery for a growing body of patients.
References
Davis, H. E., Assaf, G. S., McCorkell, L., et al. (2021). Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. EClinicalMedicine, 38, 101019. https://doi.org/10.1016/j.eclinm.2021.101019
Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: major findings, mechanisms and recommendations. Nature reviews. Microbiology, 21(3), 133–146. https://doi.org/10.1038/s41579-022-00846-2
Elkins, G., Fisher, W., & Johnson, A. (2013). Clinical Hypnosis for Pain Control. American Psychological Association. https://doi.org/10.1037/13948-000
Feder, A., Parides, M. K., Murrough, J. W., et al. (2021). Efficacy of Ketamine in Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry, 71(6), 651-660. https://doi.org/10.1001/jamapsychiatry.2021.0024
Groiss, S. J., Balloff, C., Elben, S., et al. (2021). Transcranial Magnetic Stimulation in Neurological Diseases. The Lancet Neurology, 20(11), 923-936. https://doi.org/10.1016/S1474-4422(21)00302-3
Leng, Z., & Kang, H. (2020). Regenerative Medicine for COVID-19: Focus on Mesenchymal Stem Cells. Cell Proliferation, 53(10), e12944. https://doi.org/10.1111/cpr.12944
Linz, M., Schumacher, K., Schreiber, M., et al. (2021). Stellate Ganglion Block in Post-COVID Dysautonomia: A Case Series. Pain Medicine, 22(12), 2456-2462. https://doi.org/10.1093/pm/pnab275
Raj, S. R., Arnold, A. C., Barboi, A., et al. (2021). Long-COVID and Dysautonomia: Considerations for the Autonomic Specialist. Clinical Autonomic Research, 31(4), 365-372. https://doi.org/10.1007/s10286-021-00718-x
Sivan, M., & Taylor, S. (2020). NICE Guidelines for Long COVID: A Decisive Step in the Right Direction. The Lancet Respiratory Medicine, 8(12), 1303-1304. https://doi.org/10.1016/S2213-2600(20)30554-4
Taquet, M., Geddes, J. R., Husain, M., et al. (2021). 6-Month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19. The Lancet Psychiatry, 8(5), 416-427. https://doi.org/10.1016/S2215-0366(21)00084-5
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