Hi there- I've been taking LDN (low dose naltrexone). I actually started taking it about a year before my COVID infection (started taking LDN in 2021, got COVID in November 2022 and diagnosed with long COVID this month), for chronic pain.

I am not familiar with guanfacine, but if you have concerns about trying new medications or a sensitivity to medications, I'd say LDN is worth a try. I have central sensitivity (the central nervous system aka brain becomes hypersensitive to new experiences and things that should not cause pain--the condition has a lot of overlap with long COVID) that affects how I respond to medication, and I was very apprehensive about LDN. But the more I learned about it, it's a very safe and very almost benign medication. The side effects as compared to other things recommended for chronic pain are very mild and even if you have side effects (assuming you start with a low dose and titrate slowly), the half life is so short that it's very easy to stop and wait until your symptoms get back to your baseline.

And this is coming from someone who pondered the idea of taking LDN for months upon months.

My long COVID situation is a little different because I had chronic conditions before my COVID infection with similar symptoms. The symptoms had improved, but with COVID infection got worse than before with even worse fatigue than I've ever had. The lines for me are blurred between whether it's long COVID or COVID infection exacerbating my pre-existing conditions. Originally, my conditions (POTS, small fiber neuropathy, sereonegative spondyloarthropathy--an inflammatory arthritis, and central sensitivity syndrome) were suspected to be brought on after a viral infection. Sadly, we're not surprised COVID infection even after vaccination and with Paxlovid triggered more and worse symptoms.

I shouldn't be awake this late >_