Authors' objectives: To determine if there is any evidence on the efficacy/effectiveness of Guanfacine, micronized PEA (palmitoylethanolamide) and/or amygdala and insula retraining programs in treating patients diagnosed with long COVID. To determine if there is any evidence on the efficacy/effectiveness of amygdala and insula retraining program in treating patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome.

Authors' results and conclusions: Of the thirteen published studies identified, seven of these two were on guanfacine, one on PEA, and four on amygdala-insula retraining program (AIR), were thought to be relevant and were retrieved in full for further appraisal. Of the four studies on amygdala-insula retraining program, three were in the form of clinical trial protocols without any outcome posted and will not be discussed further. No further study was identified from our manual search. At present, there is no published study reporting the efficacy/effectiveness of standalone guanfacine or PEA or combination of guanfacine, PEA and AIR in treating patients diagnosed with long COVID while there is a low level (level of evidence 4) low quality (potential selection bias, potential conflict of interest, unclear effect of co-intervention, unclear outcomes measurements) evidence reporting on the effectiveness of combined guanfacine + N-acetylcysteine (NAC) in treating patients with long COVID. In addition, there is a high level (level of evidence 1) with very low quality (bias, chance and potential effect of confounding cannot be excluded from affecting the outcome of this study) study reporting the application of AIR in treating long COVID patients. Finally, there is a small (n=33 with only 27 completed the program) case series (level of evidence 4) reporting the short-term (up to one year) effectiveness of AIR in treating patients with ME/CFS. However, it should be noted that it was not clear how the outcome was measured while potential effect of co-interventions and selection bias cannot be discounted.

Authors' methods: A comprehensive and systematic literature search was conducted on January 3 and January 4, 2024. The search was done on commercial and non-commercial medical literature databases. A combination of keywords was employed on this search. No limitation, such as on the language or date of publication, was implemented in this search. A manual search was also done on the references of the articles that were retrieved in full.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2024

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/guanfacine-micronized-pea-amygdala-insula-retraining-long-covid?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DGuanfacine%252C%2520Micronized%2520PEA%252C%2520or%2520Amygdala%2520and%2520Insula%2520Retraining%2520Programs%2520As%2520Treatment%2520for%2520Long%2520COVID%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Guanfacine,%20Micronized%20PEA,%20or%20Amygdala%20and%20Insula%20Retraining%20Programs%20As%20Treatment%20for%20Long%20COVID

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC