From a personal and professional perspective, I am very excited that there are several effective and safe COVID-19 vaccines being deployed. It is my role in life to help people and, at this time in life, I see no greater way to help people than to protect others from getting sick. This is the very definition of preventative health that we preach so much about. It is the very definition of humanity.
The advent of these vaccines has come from the sacrifices and collaboration of countless expert scientists and researchers to develop what is tantamount to the scientific achievement of anyone’s lifetime. Governments have made incredible decisions that have enabled the rapid deployment and distribution of these lifesaving measures. It is our duty to rally around these achievements and play our part to help get back to a better and safer world.
Potential Risks of Steroids and COVID-19 Vaccine
The risks are small with the COVID-19 vaccine but, as with anything in medicine, there are risks. I completely understand that there is fear and uncertainty regarding the vaccine, and I am in no way dismissing or condemning these trepidations. I encourage others to bravely move forward with the vaccination effort to help win a terrible war. We will be doing this for ourselves, our family, our country and the world at large.
Among the many concerns surrounding the vaccine, is the question of timing in relation to potential steroid injections. We, at CHARM, do steroid injections every day. And while there are very limited systemic effects from focal steroid injections to joints and the spine, there is a theoretical potential that the steroid can limit COVID-19 vaccine efficacy by decreasing our immune response. The best guidance we have is offered by the Spine Intervention Society with the following statement:
“There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine. However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than two weeks prior to a COVID-19 mRNA vaccine dose and no less than one week following a COVID-19 mRNA vaccine dose, whenever possible.” https://cdn.ymaws.com/www.spineintervention.org/resource/resmgr/factfinder/21/02.ff.37.covid.vax.pdf
In other words, steroids may be utilized when pain is severe, but should be delayed if possible. Generally speaking, steroids should always be used judiciously. These medications have several potentially negative effects on how our body addresses tissue damage, infections and hormone regulation. So, instead of using steroids to reduce the inflammation that causes pain, we can consider utilization of regenerative medicine (PRP and stem cells from BMAC) in hopes of addressing pain through tissue healing. Regenerative medicine is an effective treatment option that is safer than steroids and is intended to provide indefinite improvement in pain and function.
Board-Certified Physical Medicine & Rehabilitation by ABPMR and AOBPMR
Fellowship-Trained and Board-Certified in Pain and Musculoskeletal Medicine