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BackgroundThere 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.MethodsDevelopment 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.ResultsThis 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.ConclusionsIn 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.

Introduction: Epidural steroid injections and epidural blood patches commonly involve the injection of a small amount of radiocontrast media under fluoroscopy to properly identify the target tissue or anatomic space and prevent off-target or intravascular delivery of therapeutic or diagnostic drugs. Iodinated low osmolar non-ionic contrast media is the standard preparation used as it is considered safe and cost-effective, but gadolinium-based preparations have been used as an alternative for patients with an 'iodine'-related or radiocontrast media allergy label to prevent hypersensitivity reactions. The risk of neurotoxic events when gadolinium is inadvertently injected into the intrathecal space has been reported in recent years, raising concerns when gadolinium-based contrast media is used in lieu of iodinated low osmolar non-ionic contrast media. Methods: A retrospective review was conducted of patients who received gadolinium-based contrast media for procedures with risk of inadvertent intrathecal access from January 1, 2019 to May 1, 2022. Information on patient demographics, allergy label information, and procedure description was documented for all patients who received gadolinium-based contrast media for axial spine procedures (including epidural steroid injections, epidural blood patch procedures, and selective nerve root blocks), and all side effects reported within 1 month of the procedure were recorded. Saved fluoroscopy images of all procedures for which there was concern for possible gadolinium-based contrast media-related side effect were reviewed for evidence of inadvertent intrathecal gadolinium-based contrast media administration. Descriptive statistical analysis was performed using REDCap and IBM SPSS Statistics V.28. Results: We identified 508 patients who received gadolinium-based contrast media during a fluoroscopically guided axial spine procedure. These patients underwent 697 epidural procedures and 23 patients were identified as experiencing an adverse event that could be consistent with possible, probable, or clear signs of exposure to intrathecal gadolinium. Our calculated adverse event rate was 3.3%. Ten patients required additional medical evaluation or treatment. Discussion: Almost all patients in our cohort had an allergy label on their chart that guided the provider to switch to gadolinium-based contrast media, but most were incomplete, ill-defined, or related to allergy to iodine but not iodinated contrast media. Such practice is not recommended based on current guidelines. The current study raises concern regarding the use of gadolinium-based contrast media in axial spine procedures, with the risk of potential severe adverse events, without evidence-based need for avoiding iodinated contrast media. [ABSTRACT FROM AUTHOR]

Background Spinal cord stimulation (SCS) is an efficacious treatment for various refractory chronic pain syndromes. Serious complications including spinal cord compression (SCC) are rare with 19 previous reports which are mainly attributed to fibrotic scar tissue formation at the distal end of the leads at the location of the contacts. We report a case of SCC following SCS implantation at the lead entry location secondary to a delayed progression of spinal canal stenosis. Case presentation A patient in her early 70s underwent SCS implantation with adequate therapeutic benefit for approximately 2 years before citing complaints of increasing lower back pain and lower extremity radicular pain. Lumbar spine X-rays excluded lead migration as a causative factor. An MRI of the lumbar spine obtained 30 months following SCS implantation demonstrated a marked interval progression of central canal stenosis secondary to facet and ligamentous hypertrophy manifesting in compression of the spinal cord at the lead entry location. An L1--L2 decompressive laminectomy with hardware removal resulted in the resolution of her symptoms. A literature search conducted with the PubMed database identified previously published cases of SCC following SCS implantation which highlighted the rarity of this complication. Conclusion Our case report urges physicians of SCS patients, noting a loss of therapeutic benefit with their device, to investigate new pathologies including SCC. Furthermore, our case highlights clinical symptoms and surgical treatments of SCC. Paddle leads are more commonly implicated in published cases of SCC than percutaneous leads. Lastly, MRI conditionality is critical to identifying cases of SCC. [ABSTRACT FROM AUTHOR]

Introduction Preclinical research demonstrated water-cooled radiofrequency (CRF) ablations have a significant impact on structural and functional changes compared to standard radiofrequency (SRF) ablations. Clinical procedures utilizing RF to treat chronic pain conditions also show sustained functional outcomes. We hypothesize that the design of the RF probes plays an important role in interventional procedure success, but it remains unclear which specific design features. Methods RF ablations were performed in male Lewis rats (n=51) using multiple-sized probes for CRF (17 Ga/2 mm and 17Ga/4 mm) and SRF (22Ga/5 mm, 18Ga/10 mm and 16Ga/10 mm) to evaluate generator energy output, lesion length, axon damage by histology and nerve function analysis via electromyography. To exclude probe design variables beyond size and remain objective, we tested cooled probes with and without water circulation, which resulted in the CRF probe performing like an SRF probe. Results Consistent with our previous findings in smaller probes, CRF large probes delivered more energy (p<0.01) and generated multiple zones of thermal damage in sciatic nerves. When the water-circulating feature was turned off, however, energy output (p<0.001) and lesion length (p<0.05) was significantly reduced. CRF probes with the water circulation also featured significantly more axonal disruption, than larger sized SRF probes (p<0.0001). Conclusions Overall, this data confirms that CRF's water-circulating technology has a greater impact on energy deposition, lesion length and axon damage compared with SRF ablations. Moreover, results suggest that the structural differences between RF modalities cannot be solely attributed to probe size, and it may shed light on its differences in clinical outcomes. [ABSTRACT FROM AUTHOR]

Spinal cord stimulation (SCS) has demonstrated effectiveness for neuropathic pain. Unfortunately, some patients report inadequate long-term pain relief. Patient selection is emphasized for this therapy; however, the prognostic capabilities and deployment strategies of existing selection techniques, including an SCS trial, have been questioned. After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, a steering committee was formed to develop evidence-based guidelines for patient selection and the role of an SCS trial. Representatives of professional organizations with clinical expertize were invited to participate as committee members. A comprehensive literature review was carried out by the steering committee, and the results organized into narrative reports, which were circulated to all the committee members. Individual statements and recommendations within each of seven sections were formulated by the steering committee and circulated to members for voting. We used a modified Delphi method wherein drafts were circulated to each member in a blinded fashion for voting. Comments were incorporated in the subsequent revisions, which were recirculated for voting to achieve consensus. Seven sections with a total of 39 recommendations were approved with 100% consensus from all the members. Sections included definitions and terminology of SCS trial; benefits of SCS trial; screening for psychosocial characteristics; patient perceptions on SCS therapy and the use of trial; other patient predictors of SCS therapy; conduct of SCS trials; and evaluation of SCS trials including minimum criteria for success. Recommendations included that SCS trial should be performed before a definitive SCS implant except in anginal pain (grade B). All patients must be screened with an objective validated instrument for psychosocial factors, and this must include depression (grade B). Despite some limitations, a trial helps patient selection and provides patients with an opportunity to experience the therapy. These recommendations are expected to guide practicing physicians and other stakeholders and should not be mistaken as practice standards. Physicians should continue to make their best judgment based on individual patient considerations and preferences. [ABSTRACT FROM AUTHOR]

Background/importance Patient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated. Objective We report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials. Evidence review Medline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success. Findings Among 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registrybased reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and nonpsychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively. Conclusions Due to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role. [ABSTRACT FROM AUTHOR]

Introduction: Traditional spinal cord stimulation (t‐SCS) has been used to treat chronic pain for over 50 years. However, up to 30% of patients undergo explant, with the main indication being loss of efficacy (LoE), and few alternative treatment options exist for these patients. Strategies to mitigate LoE commonly include conversion to another type of SCS (termed 'salvage' or 'rescue'). This review summarizes the existing literature concerning the efficacy and safety of 10 kHz SCS as a salvage therapy. Methods: We searched PubMed, the Cochrane Library, ClinicalTrials.gov, and other sources between January 2009 and April 2021. Records were retained if the authors reported clinical outcomes with a minimum of ≥ 3 months of follow‐up in patients implanted with a Senza® 10 kHz SCS system in an effort to treat t‐SCS LoE. Results: Ten articles were eligible for inclusion, reporting 3 prospective studies and 7 retrospective reviews. In the single study that salvaged patients without a repeat trial prior to surgery, 81% of patients were responders (≥ 50% pain relief from baseline), with mean pain relief of 60%. Among repeat‐trial studies, the responder rate ranged from 46% to 80%, and mean pain relief from 47% to 68%. No unanticipated therapy‐related safety issues were reported among the included articles. Conclusion: Preliminary data suggest that chronic back and/or leg pain patients with t‐SCS LoE can experience improved and durable pain relief after conversion to 10 kHz SCS. However, additional research is needed to define predictors of success and establish whether salvage without a repeat trial is a viable conversion method. [ABSTRACT FROM AUTHOR]

Gadolinium-based contrast agents (GBCAs) have been suggested as off-label alternatives to iodine-based contrast agents for fluoroscopic imaging during interventional pain procedures. We report a case of accidental intrathecal administration of a GBCA during a neuraxial interventional pain procedure leading to acute gadolinium neurotoxicity, which resulted in encephalopathy and ultimately death. To our knowledge, it is the first published case of fatal intrathecal gadolinium-induced encephalopathy and the first published case of intrathecal gadoteridol causing serious neurologic complications. In addition, the case presented here is placed in context with an associated comprehensive, evidence-based review of the use of gadolinium in interventional pain procedures, addressing gadolinium chemistry and pharmacologic properties, neurotoxicity and radiology. Physicians must be aware that gadolinium poses a significant risk of acute neurotoxicity even in small doses. Until further safety research is performed, GBCAs should not be considered a safe alternative for use in neuraxial interventional spine procedures when there is a risk of inadvertent intrathecal administration. [ABSTRACT FROM AUTHOR]

Current evidence regarding diagnostic imaging methods for pediatric lumbar spondylolysis: a report from the scoliosis research Society evidence- based medicine Committee. 287 Reg Anesth Pain Med March 2021 Vol 46 No 3 PostScript Facet guidelines, serial medial branch blocks and issues surrounding recommending procedures with no mechanistic foundation Dear Editor, We thank Drs Helm and Benyamin 1 for their thoughtful comments on our facet joint consensus guidelines 2 and are delighted to respond. [Extracted from the article]

We appreciate Furman I et al i [1] comments in regards to the 2nd edition of the multi-society interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications.[2] Furman I et al i [1] emphasized the complications in patients in Endres I et al i [10] report in whom the oral anticoagulants were discontinued and an adverse cerebrovascular or cardiovascular event occurred. In conclusion, addressing a patient's anticoagulant status when considering interventional pain procedure can be challenging with the risks associated with the continuation or discontinuation of anticoagulant both being associated with devastating complications. [Extracted from the article]

Background: Intra-articular corticosteroid (IACS) injection and peri-articular corticosteroid injection are commonly used to treat musculoskeletal conditions. Results vary by musculoskeletal region, but most studies report short-term benefit with mixed results on long-term relief. Publications showed adverse events from single corticosteroid injections. Recommended effective doses were lower than those currently used by clinicians., Methods: Development of the practice guideline for joint injections was approved by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine and the participating societies. A Corticosteroid Safety Work Group coordinated the development of three guidelines: peripheral nerve blocks and trigger points; joints; and neuraxial, facet, and sacroiliac joint injections. The topics included safety of the technique in relation to landmark-guided, ultrasound-guided, or radiology-aided injections; effect of the addition of the corticosteroid on the efficacy of the injectate; and adverse events related to the injection. Experts on the topics were assigned to extensively review the literature and initially develop consensus statements and recommendations. A modified version of the US Preventive Services Task Force grading of evidence and strength of recommendation was followed. A modified Delphi process was adhered to in arriving at a consensus., Results: This guideline focuses on the safety and efficacy of corticosteroid joint injections for managing joint chronic pain in adults. The joints that were addressed included the shoulder, elbow, hand, wrist, hip, knee, and small joints of the hands and feet. All the statements and recommendations were approved by all participants and the Board of Directors of the participating societies after four rounds of discussion. There is little evidence to guide the selection of one corticosteroid over another. Ultrasound guidance increases the accuracy of injections and reduces procedural pain. A dose of 20 mg triamcinolone is as effective as 40 mg for both shoulder IACS and subacromial subdeltoid bursa corticosteroid injections. The commonly used dose for hip IACS is 40 mg triamcinolone or methylprednisolone. Triamcinolone 40 mg is as effective as 80 mg for knee IACS. Overall, IACS injections result in short-term pain relief from a few weeks to a few months. The adverse events include an increase in blood glucose, adrenal suppression, detrimental effect on cartilage lining the joint, reduction of bone mineral density, and postoperative joint infection., Conclusions: In this practice guideline, we provided specific recommendations on the role of corticosteroids in joint, bursa, and peritendon injections for musculoskeletal pain., Competing Interests: Competing interests: HTB: NIH NIAMS P30AR072579; DAP: consulting: Avanos, Boston Scientific, Medtronic, Nevro, and SI Bone; Research support: Avanos, Boston Scientific, Medtronic, Nevro; AN: speaker: Averitas Pharmaceuticals; Research: Saol Therapeutics; DS: Advisory Board, funded research: Scilex; speaker: AbbVie; MSE: funded research: SPR Therapeutics; consultant: Avanos, Abbott; MM: consultant: Juris Medicus; AA-E: consultant: Curonix; AC: research funding: NIH RM1NS128956; consultant: Swing Therapeutics, Scilex Pharmaceuticals; TLD: research support: Biohaven, NIH; consultant: Guidepoint Global; speaker honorarium: Remedy Health Media; CP: consulting: Mainstay Medical; royalties, UpToDate; SS: consultant: SPR Therapeutics, Allergan; AS: NIH R34AR080279; SPC: consulting (past 2 years): Avanos, Scilex, SPR, SWORD, Releviate (ended), Clearing (ended), Persica (inactive); research funds paid to institution: Scilex, Avanos; JAH: grants: Neiman Health Policy Institute (no number associated with this foundation grant); consulting (last 12 months): Medtronic, Relievant, Persica; DMC Chair: Balt, Rapid Medical, Arsenal; BS: consultant: State Farm, Carelon; TM: consultant, Interventional AnalgesiX; SN: consultant, Shiratonics; AW: investigator-initiated grant, Goodblends; TH: Acella: Advisory Board, speaker: Acella; CH: research grant: Nevro. The remaining authors declare no competing interests., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management., Methods: Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines., Results: After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics., Conclusions: The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required., Competing Interests: Competing interests: HTB, TLD, RLJ, HK, SLK, SN, ACSP, ES, and JVZ have no competing interests. KC: existing relationship with BD via contract for providing educational content on sepsis as a lecturer and participating in a sepsis advisory committee meeting. JSG: shareholder in startup company at UK Intralink sine, which was purchased by Spinal Simplicity but has no product on the market. MH: consults for Abbott and Medtronic. BH: consultant for Nevro and Boston Scientific. CH: principal investigator for research grant paid to institution from Nevro for investigator-initiated research study to support research coordinator efforts. Research agreement with Abbott, paid to institution (I am not the principal investigator but am involved with the 51 research.). SH: consultant/advisor for B. Baun and Shiratronics. RL: has received research funding from Sage Medical, B. Braun, Draeger, Surfacide, and Kenall, has one or more patents pending, and is a partner of RDB Bioinformatics, the company that owns OR PathTrac. He receives no funds personally from his involvement in RDB. He has spoken at educational meetings sponsored by Kenall and B. Braun. AJRM: consulting fees from Intelligent Ultrasound; honorarium for teaching from GE Healthcare. AN: Saol Therapeutics–research funds provided to my institution for research that I perform. SN: consults for Shiratronics and is a member of the Boards of Directors for the ASRA Pain Medicine and American Interventional Headache Society (AIHS). AP: paid honoraria from GE Healthcare for teaching, consultancy for Pacira Pharmaceuticals. JP: grant support from Medtronic, Boston Scientific, Abbott, NIH 2R01CA166379, NIH R01EB030324, and NIH U44NS115111. Medical advisor for Aim Medical Robotics and has stock equity. DAP: has consulted for Avanos, Boston Scientific, Medtronic, Nevro, and SI Bone. Pain Diagnostics and Interventional Care has received research support from Avanos, Boston Scientific, Medtronic, Nevro, Stimgenics, and Abbott. DAP serves on the Board of ASRA Pain Medicine. RVS: consultation fees from CIVCO., (© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: To identify Reddit users' viewpoints and inquiries about spinal cord stimulation (SCS) for chronic back pain using Reddit databases., Methods: We performed a qualitative analysis of public, anonymous threads and comments from targeted subreddits within the Reddit community. We used the Python Reddit API Wrapper to extract relevant data. A qualitative descriptive approach was employed, using natural language processing to identify and categorize common questions, concerns, and opinions shared by patients regarding SCS., Results: Our analysis included 112 posts and 448 comments. The tone of comments was neutral (n=231), followed by negative (n=121) and positive (n=96). 13 users actively encouraged other users to try the procedure, while 25 advised against it. The main topics of discussions revolved around pain relief expectations and adverse events. Almost half of users commenting about pain relief expectations reported experiencing considerably lower improvement than anticipated. Pocket pain, lead fracture/migration, infection risk, and scars were common topics of discussion among users. Furthermore, users shared strategies to mitigate postoperative discomfort and offered insights into device selection based on MRI conditionality, reprogramming need, and charging prerequisites., Conclusion: Our Reddit analysis identified potential targets for enhanced dialog between physicians and patients around anticipated pain relief, complications, and postoperative care. Reddit and other social media platforms may offer valuable opportunities for healthcare professionals to improve engagement with patients., Competing Interests: Competing interests: DAP is the President of ASRA Pain Medicine and has received consulting fees from Avanos, Boston Scientific, Nevro, SI Bone, and Medtronic. Pain Diagnostics and Interventional Care has received research support from Avanos, Boston Scientific, Medtronic, Abbott, Nevro and Stimgenics. CH has received funding from Nevro in support of research, unrelated to this work, paid to her institution., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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., Competing Interests: Competing interests: HTB, MD: NIH NIAMS P30AR072579. AC, MD: Research Funding: RM1NS128956-01A1; Consultant: Swing Therapeutics, Scilex Pharmaceuticals. SS, MD: Consultant: SPR Therapeutics, Allergan, Inc. DS, MD: Advisory Board, Funded research: Scilex; Speaker: AbbVie. AN, MD: Speaker: Averitas Pharmaceuticals; Research: Saol Therapeutics. AA-E, MD: Consultant: Curonix. TD, MD: Research support: Biohaven, NIH; Consultant: Guidepoint Global; Speaker honorarium: Remedy Health Media. MSE, MD: Funded research: SPR Therapeutics; Consultant: Avanos, Abbott. TH, MD: Acella: Advisory board, speaker: Acella. CH, MD: Research grant: Nevro, Inc. CP, MD: Consulting: Mainstay Medical; Royalties, UpToDate. BS, MD: Consultant: State Farm, Carelon. AS, MD: NIH R34AR080279. MM, MD: Consultant: Juris Medicus. JAH, MD: Grants: Neiman Health Policy Institute (there is no number associated with this foundation grant; Consulting (last 12 months): Medtronic, Relievant, Persica; DMC Chair: Balt, Rapid Medical, Arsenal. AW, MD: Investigator-initiated grant, Goodblends, PA. DAP, MD: Consulting: Avanos, Boston Scientific, Medtronic, Nevro, and SI Bone. Research support: Avanos, Boston Scientific, Medtronic, Nevro, Stimgenics, Abbott. SPC, MD: Consulting (past 2 years): Avanos, Scilex, SPR, SWORD, Releviate (ended), Clearing (ended), Persica (inactive); Research funds paid to institution: Scilex, Avanos. TM, MD: Consultant, Interventional AnalgesiX. The remaining authors declare no competing interests., (© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.)