tetano
Editor, Senior Moderator
Reg Anesth Pain Med
. 2026 Feb 27:rapm-2025-107556.
doi: 10.1136/rapm-2025-107556. Online ahead of print.
Multisociety multispecialty position statement on corticosteroid injections and influenza and COVID-19 vaccine administration
Honorio T Benzon[SUP] 1 [/SUP], John FitzGerald[SUP] 2 [/SUP], John P Flaherty[SUP] 3 [/SUP], Steven Paul Cohen[SUP] 4 [/SUP], Tina L Doshi[SUP] 5 6 [/SUP], Maged Mina[SUP] 7 [/SUP], Salahadin Abdi[SUP] 8 [/SUP], Alaa Abd-Elsayed[SUP] 9 [/SUP], Andrea Chadwick[SUP] 10 [/SUP], Maxim S Eckmann[SUP] 7 [/SUP], Dalia Elmofty[SUP] 11 [/SUP], Joshua Adam Hirsch[SUP] 12 [/SUP], Thanh Hoang[SUP] 13 [/SUP], Christine Hunt[SUP] 14 [/SUP], Laxmaiah Manchikanti[SUP] 15 16 [/SUP], Ameet Nagpal[SUP] 17 [/SUP], Ariana M Nelson[SUP] 18 [/SUP], Carlos Pino[SUP] 19 [/SUP], David Anthony Provenzano[SUP] 20 [/SUP], Maunak Rana[SUP] 11 [/SUP], Jessica Rivera[SUP] 21 [/SUP], Shalini Shah[SUP] 18 [/SUP], Hariharan Shankar[SUP] 22 [/SUP], Harsha Shanthanna[SUP] 23 [/SUP], Byron Schneider[SUP] 24 [/SUP], Dmitri Souza[SUP] 25 [/SUP], Alison Stout[SUP] 26 [/SUP], Ajay D Wasan[SUP] 27 [/SUP], Samer Narouze[SUP] 28 [/SUP], Tim Maus[SUP] 29 [/SUP]
Affiliations
Background: Corticosteroid injections (CSIs) are widely employed for chronic pain. These injections include peripheral nerve blocks and trigger point injections, injections of large appendicular joints, the axial facet and sacroiliac joints, and the epidural space. These injections may be performed in patients who have been recently vaccinated or plan to be vaccinated. This multisociety multispecialty position statement aims to develop evidence-based statements and recommendations (SRs) on the safe interval between CSIs and COVID-19 and influenza vaccine administration.
Methods: Development of the position statement was approved by the American Society of Regional Anesthesia and Pain Medicine Board of Directors and several other societies that agreed to participate. The scope of the SRs was agreed on to include the efficacy of COVID-19 and influenza vaccines, adverse events related to the CSIs, specifically the effect of CSIs on the hypothalamic-pituitary axis, incidence of COVID-19 in patients who had CSIs during the pandemic, incidence of influenza in patients who had CSIs during the influenza season, and recommend a reasonable interval between CSIs and COVID-19 and influenza vaccination 20 mg/day of prednisone s. Experts were assigned topics to perform a comprehensive literature review and draft SRs, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. A modified version of the US Preventive Services Task Force grading of evidence and strength of recommendation was followed.
Results: All SRs were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Boards of Directors of the participating societies also approved all SRs. If a vaccine has been recently administered or planned, then for non-urgent indications, the CSI should be offered at least 1 week before or after vaccine administration. For healthy patient(s), CSI, or vaccine administration may be performed without a 7-day interval after informed discussion with the patient and consent regarding the risk of blunted vaccine efficacy. For non-healthy patients, shared decision-making should include discussion of diminished vaccine effectiveness and the possibility of influenza or COVID-19 infection.
Conclusions: In this position statement, we provide recommendations on the optimal timing between CSIs and COVID-19 or influenza vaccine.
Keywords: CHRONIC PAIN; COVID-19; Corticosteroid injection.
. 2026 Feb 27:rapm-2025-107556.
doi: 10.1136/rapm-2025-107556. Online ahead of print.
Multisociety multispecialty position statement on corticosteroid injections and influenza and COVID-19 vaccine administration
Honorio T Benzon[SUP] 1 [/SUP], John FitzGerald[SUP] 2 [/SUP], John P Flaherty[SUP] 3 [/SUP], Steven Paul Cohen[SUP] 4 [/SUP], Tina L Doshi[SUP] 5 6 [/SUP], Maged Mina[SUP] 7 [/SUP], Salahadin Abdi[SUP] 8 [/SUP], Alaa Abd-Elsayed[SUP] 9 [/SUP], Andrea Chadwick[SUP] 10 [/SUP], Maxim S Eckmann[SUP] 7 [/SUP], Dalia Elmofty[SUP] 11 [/SUP], Joshua Adam Hirsch[SUP] 12 [/SUP], Thanh Hoang[SUP] 13 [/SUP], Christine Hunt[SUP] 14 [/SUP], Laxmaiah Manchikanti[SUP] 15 16 [/SUP], Ameet Nagpal[SUP] 17 [/SUP], Ariana M Nelson[SUP] 18 [/SUP], Carlos Pino[SUP] 19 [/SUP], David Anthony Provenzano[SUP] 20 [/SUP], Maunak Rana[SUP] 11 [/SUP], Jessica Rivera[SUP] 21 [/SUP], Shalini Shah[SUP] 18 [/SUP], Hariharan Shankar[SUP] 22 [/SUP], Harsha Shanthanna[SUP] 23 [/SUP], Byron Schneider[SUP] 24 [/SUP], Dmitri Souza[SUP] 25 [/SUP], Alison Stout[SUP] 26 [/SUP], Ajay D Wasan[SUP] 27 [/SUP], Samer Narouze[SUP] 28 [/SUP], Tim Maus[SUP] 29 [/SUP]
Affiliations
- PMID: 41760373
- DOI: 10.1136/rapm-2025-107556
Background: Corticosteroid injections (CSIs) are widely employed for chronic pain. These injections include peripheral nerve blocks and trigger point injections, injections of large appendicular joints, the axial facet and sacroiliac joints, and the epidural space. These injections may be performed in patients who have been recently vaccinated or plan to be vaccinated. This multisociety multispecialty position statement aims to develop evidence-based statements and recommendations (SRs) on the safe interval between CSIs and COVID-19 and influenza vaccine administration.
Methods: Development of the position statement was approved by the American Society of Regional Anesthesia and Pain Medicine Board of Directors and several other societies that agreed to participate. The scope of the SRs was agreed on to include the efficacy of COVID-19 and influenza vaccines, adverse events related to the CSIs, specifically the effect of CSIs on the hypothalamic-pituitary axis, incidence of COVID-19 in patients who had CSIs during the pandemic, incidence of influenza in patients who had CSIs during the influenza season, and recommend a reasonable interval between CSIs and COVID-19 and influenza vaccination 20 mg/day of prednisone s. Experts were assigned topics to perform a comprehensive literature review and draft SRs, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. A modified version of the US Preventive Services Task Force grading of evidence and strength of recommendation was followed.
Results: All SRs were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Boards of Directors of the participating societies also approved all SRs. If a vaccine has been recently administered or planned, then for non-urgent indications, the CSI should be offered at least 1 week before or after vaccine administration. For healthy patient(s), CSI, or vaccine administration may be performed without a 7-day interval after informed discussion with the patient and consent regarding the risk of blunted vaccine efficacy. For non-healthy patients, shared decision-making should include discussion of diminished vaccine effectiveness and the possibility of influenza or COVID-19 infection.
Conclusions: In this position statement, we provide recommendations on the optimal timing between CSIs and COVID-19 or influenza vaccine.
Keywords: CHRONIC PAIN; COVID-19; Corticosteroid injection.