Multisociety multispecialty position statement on corticosteroid injections and influenza and COVID-19 vaccine administration

Authors

• Honorio T. Benzon, Northwestern University Feinberg School of Medicine, Chicago, IL
• John FitzGerald, UCLA, Los Angeles, CA
• John P. Flaherty, Northwestern University Feinberg School of Medicine, Chicago, IL
• Steven Paul Cohen, Northwestern University Feinberg School of Medicine, Chicago, IL
• Tina L. Doshi, Johns Hopkins Medicine, Baltimore, MD
• Maged Mina, The University of Texas Health Science Center, San Antonio, TX
• Salahadin Abdi, MD Anderson Cancer Center, Houston, TX
• Alaa Abd-Elsayed, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI
• Andrea Chadwick, The University of Kansas School of Medicine, Kansas City, KS
• Maxim S. Eckmann, The University of Texas Health Science Center, San Antonio, TX
• Dalia Elmofty, University of Chicago Medical Center, Chicago, IL
• Joshua Adam Hirsch, Massachusetts General Hospital, Boston, MA
• Thanh Hoang, Walter Reed Army Medical Center, Bethesda, MD
• Christine Hunt, Mayo Clinic, Rochester, MN
• Laxmaiah Manchikanti, University of Louisville Health Sciences Center, Louisville, KY
• Ameet Nagpal, Medical University of South Carolina, Charleston, SC
• Ariana M. Nelson, University of California Irvine, Irvine, CA
• Carlos Pino, Naval Medical Center San Diego, San Diego, CA
• David Anthony Provenzano, Pain Diagnostics and Interventional Care, Sewickley, PA
• Maunak Rana, University of Chicago Medical Center, Chicago, IL
• Jessica Rivera, LSU Health Sciences Center - New OrleansFollow
• Shalini Shah, University of California Irvine, Irvine, CA
• Hariharan Shankar, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, WI
• Harsha Shanthanna, McMaster University, Hamilton, Ontario, Canada
• Byron Schneider, Vanderbilt University Medical Center, Nashville, TN
• Dmitri Souza, Summa Western Reserve Hospital, Cuyahoga Falls, OH
• Alison Stout, Cleveland Clinic Neurological Institute, Cleveland, OH
• Ajay D. Wasan, University of Pittsburgh School of Medicine, Pittsburgh, PA
• Samer Narouze, University Hospitals of Cleveland, Cleveland, OH
• Tim Maus, Mayo Clinic, Rochester, MN

Document Type

Article

Publication Date

2-27-2026

Publication Title

Regional Anesthesia and Pain Medicine

Abstract

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.

PubMed ID

41760373

Rights

© American Society of Regional Anesthesia & Pain Medicine 2026

Recommended Citation

Benzon, Honorio T.; FitzGerald, John; Flaherty, John P.; Cohen, Steven Paul; Doshi, Tina L.; Mina, Maged; Abdi, Salahadin; Abd-Elsayed, Alaa; Chadwick, Andrea; Eckmann, Maxim S.; Elmofty, Dalia; Hirsch, Joshua Adam; Hoang, Thanh; Hunt, Christine; Manchikanti, Laxmaiah; Nagpal, Ameet; Nelson, Ariana M.; Pino, Carlos; Provenzano, David Anthony; Rana, Maunak; Rivera, Jessica; Shah, Shalini; Shankar, Hariharan; Shanthanna, Harsha; Schneider, Byron; Souza, Dmitri; Stout, Alison; Wasan, Ajay D.; Narouze, Samer; and Maus, Tim, "Multisociety multispecialty position statement on corticosteroid injections and influenza and COVID-19 vaccine administration" (2026). School of Medicine Faculty Publications. 4498.
https://digitalscholar.lsuhsc.edu/som_facpubs/4498
10.1136/rapm-2025-107556