Here at Integrative Pain Specialists (IPS), patients have asked how safe taking oral steroids or steroid injections is during the COVID-19 pandemic. We’ve fielded this question at least a dozen times in the past month alone. This is an especially important concern in the pain world since we use steroids frequently for inflammation and pain control. Unfortunately, steroids also suppress the immune system.
The question is an understandable one, given the contagious nature of the virus; a suppressed immune system may not protect the body well enough against dangerous pathogens. In this article I will go over our policy, and the consensus guidelines regarding steroid treatment and COVID-19 from the American Society of Pain and Neuroscience (ASPN).
Oral steroids expose the body to a higher cumulative dose when compared to a local steroid injection. When you take corticosteroid pills, the drug is absorbed in the digestive tract and spread throughout the body. Since the drug works systemically, a higher dose is needed to achieve a significant anti-inflammatory effect. This form of steroid treatment involves the greatest risk of immune system suppression. As such, our recommendation is that nobody should receive oral steroids until they have been completely vaccinated for COVID-19.
It is much less clear whether steroid injections increase infection risk compared to oral steroids. Previous studies have demonstrated that there is still systemic absorption following both epidural and joint steroid injections. However, there have not been any conclusive studies demonstrating a significant increase in infection risk. According to ASPN:
“While epidural steroids may be absorbed systemically, based on current dosing strategies and the pharmacodynamics of these injections, they are unlikely to demonstrate the immunosuppressive effects associated with chronic high-dose systemic steroid use.”
Therefore, we are still scheduling patients for pain-relieving steroid injections, regardless of their vaccination status. We believe that the pain reliving benefits outweigh the very small risk of systemic immune suppression. However, if you are planning on getting vaccinated around the same time as a steroid injection, we may still recommend waiting a short time before going forward with your procedure.
The COVID-19 Vaccine
Even if steroid injections are unlikely to increase the risk of infection, it is still unclear whether or not they will interfere with the any of the COVID-19 vaccines. Essentially, a vaccine is a way of arming your body against a specific pathogen. To do this, a vaccine relies upon your body’s immune system responding appropriately. If the immune system is suppressed (potentially because of steroids), there is concern that the vaccine may not be as effective as it otherwise would be.
Older studies indicate that people on chronic oral steroids had a decreased immunization response to both pneumococcal and hepatitis B vaccines. Thus far, there is no evidence to suggest that local administration of steroid via injection leads to decreased efficacy of the COVID-19 vaccine. Despite this lack of evidence, The American Academy of Orthopaedic Surgeons (AAOS) still recommends avoiding any steroid injection for two weeks before and one week after a COVID-19 vaccine. This is a safeguard to ensure successful vaccination and one that we follow here at IPS.
At the end of the day, steroid injections are elective procedures, and we would rather be cautious and follow these guidelines; however, individual circumstances always vary, and we would be happy to discuss your unique situation during your appointment. If you are struggling with pain but are hesitant to have a steroid injection because you are not vaccinated, we’d love to meet with you. There are a number of treatments, both medical and interventional, that we offer that do not involve steroids.
Q: I am in acute pain and have already had my COVID-19 vaccine. It has been over two weeks since I was vaccinated. Could I benefit from oral steroids?
A: Yes – make an appointment to see one of our skilled providers and we will determine if oral steroids are appropriate for your unique situation.
Q: I am in acute pain but have not yet had my COVID-19 vaccine, or I just recently had it in the last two weeks. Could I benefit from oral steroids?
A: No, the increased risk of infection likely outweighs the benefits of the oral steroids.
Q: I have a steroid injection currently scheduled and am fully vaccinated. Am I at an increased risk for COVID-19 because of this?
A: Unlikely; no study has yet demonstrated that a steroid injection will cause any appreciable immune suppression.
Q: I have a steroid injection scheduled, but I am supposed to get my vaccine one week before the steroid injection. Should I reschedule?
A: It depends; we may recommend that you postpone the procedure until you have been fully vaccinated for at least one week, but if your level of pain is severe enough, the pain relief that you may get from such an injection would likely outweigh the small risk of decreased vaccine efficacy. In this case we would use shared medical decision making to reach a conclusion based on your unique circumstances.
Hopefully this has helped clear up the misconceptions and questions regarding steroid use and COVID-19. Please call or make an appointment if you have any further questions. We hope to see you soon here at Integrative Pain Specialists – stay safe!