pISSN 2005-9159
eISSN 2093-0569

Review Article

Korean J Pain 2022; 35(1): 14-21

Published online January 1, 2022 https://doi.org/10.3344/kjp.2022.35.1.14

Copyright © The Korean Pain Society.

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

Sung Man Hong , Yeon Wook Park , Eun Joo Choi

Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to:Eun Joo Choi
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beongil, Bundang-gu, Seongnam 13620, Korea
Tel: +82-31-787-7499
Fax: +82-31-787-4063
E-mail: ejchoi@snubh.org

Handling Editor: Kyung Hoon Kim

Received: August 18, 2021; Revised: November 4, 2021; Accepted: November 12, 2021

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

Keywords: Adaptive Immunity, Coronavirus, COVID-19, COVID-19 Vaccines, Immunization Programs, Immunosuppression, Injections, Nerve Block, Pain, Pain Management, Pandemics, Social Isolation, Steroids.