{
  "abstract": "Background There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic–pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.Methods Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.Results This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.Conclusions In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Honorio T Benzon"
    },
    {
      "affiliations": [
        "Department of Anesthesia, University of Chicago Medical Center, Chicago, Illinois, USA"
      ],
      "name": "Dalia Elmofty"
    },
    {
      "affiliations": [
        "Anesthesiology, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, Wisconsin, USA"
      ],
      "name": "Hariharan Shankar"
    },
    {
      "affiliations": [
        "Department of Anesthesia, University of Chicago Medical Center, Chicago, Illinois, USA"
      ],
      "name": "Maunak Rana"
    },
    {
      "affiliations": [
        "Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA"
      ],
      "name": "Andrea L Chadwick"
    },
    {
      "affiliations": [
        "University of California Irvine, Orange, California, USA"
      ],
      "name": "Shalini Shah"
    },
    {
      "affiliations": [
        "Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA"
      ],
      "name": "Dmitri Souza"
    },
    {
      "affiliations": [
        "Orthopaedics and PM&R, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Ameet S Nagpal"
    },
    {
      "affiliations": [
        "Pain Medicine, MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Salahadin Abdi"
    },
    {
      "affiliations": [
        "Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA"
      ],
      "name": "Christian Rafla"
    },
    {
      "affiliations": [
        "University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA"
      ],
      "name": "Alaa Abd-Elsayed"
    },
    {
      "affiliations": [
        "Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA"
      ],
      "name": "Tina L Doshi"
    },
    {
      "affiliations": [
        "Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Maxim S Eckmann"
    },
    {
      "affiliations": [
        "Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Thanh D Hoang"
    },
    {
      "affiliations": [
        "Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA"
      ],
      "name": "Christine Hunt"
    },
    {
      "affiliations": [
        "Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA"
      ],
      "name": "Carlos A Pino"
    },
    {
      "affiliations": [
        "Orthopedic Surgery, LSUHSC, New Orleans, Louisiana, USA"
      ],
      "name": "Jessica Rivera"
    },
    {
      "affiliations": [
        "PM&R, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Byron J Schneider"
    },
    {
      "affiliations": [
        "PM&R, Cleveland Clinic, Cleveland, Ohio, USA"
      ],
      "name": "Alison Stout"
    },
    {
      "affiliations": [
        "American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Angela Stengel"
    },
    {
      "affiliations": [
        "Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Maged Mina"
    },
    {
      "affiliations": [
        "Medicine (Rheumatology), UCLA, Los Angeles, California, USA"
      ],
      "name": "John D FitzGerald"
    },
    {
      "affiliations": [
        "Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Joshua A Hirsch"
    },
    {
      "affiliations": [
        "University of Pittsburgh Health Sciences, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Ajay D Wasan"
    },
    {
      "affiliations": [
        "University of Louisville Health Sciences Center, Louisville, Kentucky, USA"
      ],
      "name": "Laxmaiah Manchikanti"
    },
    {
      "affiliations": [
        "Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, USA"
      ],
      "name": "David Anthony Provenzano"
    },
    {
      "affiliations": [
        "Anesthesia, Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA"
      ],
      "name": "Samer Narouze"
    },
    {
      "affiliations": [
        "Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA",
        "Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA"
      ],
      "name": "Steven P Cohen"
    },
    {
      "affiliations": [
        "Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Timothy P Maus"
    },
    {
      "affiliations": [
        "Department of Anesthesiology and Perioperative Medicine, University of California Irvine, Irvine, California, USA",
        "Department of Aerospace Medicine, Exploration Medical Capability, Johnson Space Center"
      ],
      "name": "Ariana M Nelson"
    },
    {
      "affiliations": [
        "Anesthesia, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Harsha Shanthanna"
    }
  ],
  "title": "Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, and the International Pain and Spine Intervention Society",
  "uid": "7d7dc997-3990-505f-8137-69871b6cfcf0"
}