Dear Editor,
We thank Dr. Mungmunpuntipantip for his comments and feedback [1] on our letter entitled “Post-SARS-CoV-2-vaccine shoulder pain: Is it relevant to the vaccine injection? - Correspondence.” [2].
The idea of correlating relevant shoulder pain with vaccine injection originated from feedbacks of colleagues. Most of them did not have any symptom after vaccination, but some suffered from shoulder pain. As many of them felt the pain to start on the second day and after the second vaccination, an online questionnaire was conducted. Data collected 1 week after the questionnaire was sent out showed the study design needed improvement during data processing, and the main limitations were clarified at the end of the article. However, based on the timeliness to publish this research and the urgency to attract public's attention on this issue, the preliminary results were released.
China is one of the most supportive countries in the world in advocating vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From the feedback of participants, mRNA vaccine caused more shoulder pain than other inactivated vaccines. However, the sample size of participants getting mRNA vaccine was relatively small which might affect the statistical accuracy.
What Dr. Mungmunpuntipantip has suggested is very pertinent, and the technique of administration of vaccination is a factor that should be considered. The site of injection can also affect pain. Intramuscular vaccination into deltoid muscle can cause subdeltoid bursitis, and unskilled techniques in administration can cause irritation of subacromial bursa to result in shoulder pain [3]. According to Pettyjohn EW et al., pre-existing diseases of shoulder joint and background physiological status can also be risk factors related to vaccination shoulder pain [4]. These factors as mentioned above will be added to our new questionnaire, and more information on post vaccination activities will also be collected. With increase in sample size, inclusion of more representative populations, and exclusion of as many confounding factors as possible, further correlation between post-SARS-CoV-2-vaccine shoulder pain and vaccine injection can lead to more definitive and convincing conclusions.
Ethical approval
This study was approved by the Ethics Committee of the People's Hospital of Xiangxi Autonomous Prefecture (2021–004).
Sources of funding
No.
Author contribution
ZD contributed to conceptualization and writing. XZ contributed to investigation and visualization. JX contributed to review and editing. All authors reviewed and approved the final manuscript.
Research registration Unique Identifying number (UIN)
1. Name of the registry:
NA.
2. Unique Identifying number or registration ID:
NA.
3. Hyperlink to your specific registration (must be publicly accessible and will be checked):
NA.
Guarantor
Zhenhan Deng.
Provenance and peer review
Uninvited reply letter, internally reviewed.
Declaration of competing interest
No.
References
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