The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Risk analysis of musculoskeletal pain intervention using corticosteroid during COVID-19 pandemic: a cohort study

  • Azwan Aziz, Mohamad (Sports Medicine Department, University Malaya Medical Centre) ;
  • Nahar Azmi, Mohamed (Sports Medicine Department, University Malaya Medical Centre)
  • Received : 2022.07.18
  • Accepted : 2022.10.05
  • Published : 2023.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Most international bodies recommended against musculoskeletal steroid injection during the COVID-19 pandemic, fearing that the immunosuppressive effects of the steroid could worsen COVID-19 infection, thus prolonging the suffering of patients with severe musculoskeletal disease. The authors' aim is to analyze the risk of COVID-19 infection after musculoskeletal injections. Methods: This is a retrospective study of patients who visited a sports medicine clinic and received musculoskeletal steroid injections between January 1, 2020 and February 28, 2021. The collected data was compared with the national COVID-19 registry to identify positive COVID-19 patients. The patients were only considered positive for COVID-19 following corticosteroid injection within 3 months after injection. Results: Out of 502 steroid injections; 79.7% (n = 400) received a single injection in one day, 19.1% (n = 96) received steroid injections at 2 sites in one day, and 1.2% (n = 6) received steroid injections at 3 sites in one day. Using the Fisher's exact test, there was no statistically significant association of COVID-19 infection between the steroid group and control group (relative risk, 1.44; 95% confidence interval, 0.9-23.1, P = 0.654). Only one patient contracted mild COVID-19 with no post COVID complications. Conclusions: The authors recommend the use of musculoskeletal steroid injections in clinically indicated situation without having increased risk of COVID-19.

Keywords

Acknowledgement

I would like to thank the Director General, Ministry of Health, Malaysia, Tan sri Dato Sri Dr Noor Hisham bin Abdullah and the Head of Centre for Disease Control, Ministry of Health, Malaysia, Dr Wan Noraini binti Wan Mohamed Noor for their support and high contribution in this study.

References

  1. Stephens MB, Beutler AI, O'Connor FG. Musculoskeletal injections: a review of the evidence. Am Fam Physician 2008; 78: 971-6. 
  2. MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology 2009; 252: 647-61.  https://doi.org/10.1148/radiol.2523081929
  3. Ericson-Neilsen W, Kaye AD. Steroids: pharmacology, complications, and practice delivery issues. Ochsner J 2014; 14: 203-7. 
  4. Sytsma TT, Greenlund LK, Greenlund LS. Joint corticosteroid injection associated with increased influenza risk. Mayo Clin Proc Innov Qual Outcomes 2018; 2: 194-8.  https://doi.org/10.1016/j.mayocpiqo.2018.01.005
  5. National Health Service. Clinical guide for the management of patients with musculoskeletal and rheumatic conditions on corticosteroids during the coronavirus pandemic [Internet]. London: National Health Service; 2020. Available at: https://www.csp.org.uk/media/1264903. 
  6. Shanthanna H, Cohen SP, Strand N, Lobo CA, Eldabe S, Bhatia A, et al. Recommendations on chronic pain practice during the COVID-19 pandemic. ASRA/ESRA COVID-19 guidance for chronic pain practice [Internet]. Pittsburgh (PA): American Society of Regional Anesthesia and Pain Medicine; 2020. Available at: https://www.hlz.hr/wp-content/uploads/2020/04/asra_esra_covid-19_and_chronic_pain-1.pdf. 
  7. Dalili D, Fairhead R, Mermekli A, Papanikitas J, Teh J, Hughes R, et al. Impact of the COVID-19 pandemic on corticosteroid injection services: a national survey of members of the British Society of Skeletal Radiologists (BSSR). Br J Radiol 2021; 94: 20210327.  https://doi.org/10.1259/bjr.20210327
  8. Friedly JL, Comstock BA, Heagerty PJ, Bauer Z, Rothman MS, Suri P, et al. Systemic effects of epidural steroid injections for spinal stenosis. Pain 2018; 159: 876-83.  https://doi.org/10.1097/j.pain.0000000000001158
  9. Abdul AJ, Ghai B, Bansal D, Sachdeva N, Bhansali A, Dhatt SS. Hypothalamic pituitary adrenocortical axis suppression following a single epidural injection of methylprednisolone acetate. Pain Physician 2017; 20: E991-1001.  https://doi.org/10.36076/ppj/2017.7.E991
  10. Iranmanesh A, Gullapalli D, Singh R, Veldhuis JD. Hypothalamo-pituitary-adrenal axis after a single epidural triamcinolone injection. Endocrine 2017; 57: 308-13.  https://doi.org/10.1007/s12020-017-1357-7
  11. Jayaraj VJ, Rampal S, Ng CW, Chong DWQ. The epidemiology of COVID-19 in Malaysia. Lancet Reg Health West Pac 2021; 17: 100295.  https://doi.org/10.1016/j.lanwpc.2021.100295
  12. Bugeja M, Mariani J, Dowling J, Stringaro G, Portelli JL, Sant K, et al. Musculoskeletal steroid injections during the COVID-19 pandemic. J Orthop 2021; 26: 103-6.  https://doi.org/10.1016/j.jor.2021.07.017
  13. McKean D, Chung SL, Fairhead R, Bannister O, Magliano M, Papanikitas J, et al. Corticosteroid injections during the COVID-19 pandemic: experience from a UK centre. Bone Jt Open 2020; 1: 605-11.  https://doi.org/10.1302/2633-1462.19.BJO-2020-0130.R1
  14. Azwan Aziz M, Abu Hanifah R, Mohd Nahar AM. Musculoskeletal corticosteroid injection during COVID-19 pandemic in Sabah: is it safe? Adv Orthop 2021; 2021: 8863210.  https://doi.org/10.1155/2021/8863210
  15. Chang CY, Prabhakar A, Staffa SJ, Husseini JS, Kheterpal AB, Simeone FJ, et al. Symptomatic COVID-19 infections in outpatient image-guided corticosteroid injection patients during the lockdown phase. Skeletal Radiol 2021; 50: 1117-23. https://doi.org/10.1007/s00256-020-03656-w