The guidance around CSI & Covid rightly advise only to use in ‘essential’ circumstances, and this is then qualified as ‘after having tried all other options’. The risk here is that a CSI is then expected *because* other care hasn’t worked, rather than due to severity criteria.

If you have pain which is causing mild to moderate functional impact and needing intermittent analgesia then a CSI is not advised right now, even if it might be the only thing that will help (which is unlikely).

Indications are (IMO) inability to do essential tasks (not hobbies), sleep disturbance and distressing pain despite regular analgesia. Also in acute inflammatory arthropathy for joint preservation.

From my experience this would rule out perhaps 80% of those I typically see. I feel this needs to be more clearly explained to patients before they arrive in clinic with the expectation it’s business as usual.

Otherwise the consultation can descend into a haggling situation where the clinician is struggling to clarify the true severity (humans aren’t always good at making decisions in their best interests!).