Korean J Pain.  2022 Jan;35(1):14-21. 10.3344/kjp.2022.35.1.14.

Steroid injections in pain management: influence on coronavirus disease 2019 vaccines

• Hong SM
• Park YW
• Choi EJ

• KMID: 2524641
• DOI: http://doi.org/10.3344/kjp.2022.35.1.14

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, which has been rampant since the end of 2019, has evidently affected pain management in clinical practice. Fortunately, a COVID-19 vaccination program is currently in progress worldwide. There is an ongoing discussion that pain management using steroid injections can decrease COVID-19 vaccine efficacy, although currently there is no direct evidence to support this statement. As such, the feeling of pain in patients is doubled in addition to the co-existing ill-effects of social isolation associated with the pandemic. Thus, in the COVID-19 era, it has become necessary that physicians be able to provide high quality pain management without negatively impacting COVID-19 vaccine efficacy. Steroids can alter the entire process involved in the generation of adaptive immunity after vaccination. The period of hypophysis-pituitary-adrenal axis suppression is known to be 1 to 4 weeks after steroid injection, and although the exact timing for peak efficacy of COVID-19 vaccines is slightly different for each vaccine, the average is approximately 2 weeks. It is suggested to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses) for the doubleshot vaccines, and for 2 weeks in total (1 week before and after vaccination) for a single-shot vaccine. This review focuses on the basic concepts of the various COVID-19 vaccines, the effect of steroid injections on vaccine efficacy, and suggestions regarding an appropriate interval between the administration of steroid injections and the COVID-19 vaccine.

Keyword

Adaptive Immunity; Coronavirus; COVID-19; COVID-19 Vaccines; Immunization Programs; Immunosuppression; Injections; Nerve Block; Pain; Pain Management; Pandemics; Social Isolation; Steroids

Figure

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  Fig. 1 Suitable time interval between pain management using steroids and coronavirus disease 2019 (COVID-19) vaccination, before and after the vaccination. In a 2 shot vaccine (AstraZeneca AZD1222, Pfizer-BioNTech BNT162b2, Moderna mRNA-1273), it is desirable to avoid steroid injections for a total of 4 weeks (1 week before and after the two vaccine doses), and in a single shot vaccine (Johnson & Johnson Ad26.COV2.S), this duration is 2 weeks in total (1 week before and after vaccination).

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