Percutaneous Auricular Nerve Stimulation for Treating Post-COVID Fatigue (PAuSing-Post-COVID Fatigue)

Fatigue is a very common symptom of Long COVID. Feedback from patients has highlighted the devastating impact of post-Covid Fatigue (pCF) on lives as well as the need for novel therapeutic options. Interventions that enhance existing therapies and empower those suffering with pCF to manage their own treatment at home are particularly needed. People with the rare disease, primary Sjögren s syndrome, also show fatigue. We previously demonstrated in such people that non-invasive vagus nerve stimulation (nVNS) at the neck delivered twice daily for 26 days significantly reduced fatigue symptoms. Here, we will extend this work to test whether nVNS can reduce fatigue in adults with pCF. The vagus nerve has a branch which supplies the skin around the ear canal. Stimulating the ear can be easily and safely self-administered at home using a handheld battery-powered transcutaneous electrical nerve stimulation (TENS) device, available over the counter without prescription. We will focus on people diagnosed with COVID19 but not requiring hospital in-patient treatment. In this study, 96 participants with pCF will be randomly assigned to one of three study groups. One group will asked to stimulate the part of the ear containing the vagus nerve. For comparison, the other two groups will either be asked to stimulate a part of the ear that does not contain the vagus, or given an electrode that is inactive. After 8 weeks, changes in fatigue severity will be measured using questionnaires and wearable technologies. We will also use lab-based tests to measure changes in brain circuits. From week 9, all participants will switch to receive nVNS until week 16 and the above measurements repeated.