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http://dx.doi.org/10.3344/kjp.2022.35.1.14

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

Hong, Sung Man (Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital)
Park, Yeon Wook (Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital)
Choi, Eun Joo (Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital)
Publication Information
The Korean Journal of Pain / v.35, no.1, 2022 , pp. 14-21 More about this Journal
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 double-shot 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.
Keywords
Adaptive Immunity; Coronavirus; COVID-19; COVID-19 Vaccines; Immunization Programs; Immunosuppression; Injections; Nerve Block; Pain; Pain Management; Pandemics; Social Isolation; Steroids;
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