Should I get a steroid injection?

It’s most likely not a surprise to you, that as a chiropractic physician who deals with pain, I get asked about corticosteroid injection frequently. People want to know if steroid injections will help their pain. Different physicians have varying opinions about this treatment option. As a student in graduate school, I recall my professor would tell his patients if they received a steroid injection he would no longer treat them; I find this to be extreme. However, I do believe caution needs to be taken when considering this treatment.

In my professional opinion many healthcare physicians move toward this option too quickly. The cost of this treatment is fairly low and it’s a quick procedure which makes it easy for the doctor to do. Doctors also recommend injections when they are not entirely sure what treatment they want to do for their patients severe pain. It’s not that hard to do a quick injection to mask the pain and give fast relief; however will the injection solve the problem or create more?

Things to consider before getting a corticosteroid injection; first do you know what your condition is? Corticosteroid injections should not be given in place of a proper diagnosis. When receiving a steroid injection to help with low back pain, you as a patient should know what condition is being treated. Studies show that steroid injections are a pretty good option for disc herniations and nerve root irritations but not as effective for stenosis in the spine. It is also a poor idea for muscle or ligament tears or joint instability. You need to consider your age; elderly patients have a higher risk to side effects. What is your current health status do you have a condition that may be exacerbated by steroid therapy? And have you tried other less harmful options such as NSAIDs (Ibuprophen, Advil, etc.), analgesics (Tylenol, ice, heat), chiropractic or physical therapy?

Common concerns with steroid injections are:

Ligaments laxity with possible tendon weakening and/or rupture
Reduced immune response
Joint infection
Nerve damage
Thinning of skin and soft tissue around the injection site
Bone loss (potential fracture or osteoporosis)

Dr. Sholomo Mandell an orthopedic physician recently did a study and believes that steroids “might stay in the epidural space.” Which can be one of the reasons why bone loss occurs with steroid injections.

Now with all that said, I don’t object to patient’s getting corticosteroid injections when therapy has been attempted and the response is slower than expected. There are possible side effects to any procedure; you just need to weigh the potential benefits to the potential side effects. If you have tried therapy and have a clear diagnosis and results are slow, then an injection may not be a bad idea. If you are aware of the potential side effects then I believe there are things that can be done to help reduce the chance of side effects.

Increase Vitamin D
Increase your calcium
Take glucosamine and condroitin
Take Echinacea

If you decide to have an injection, “Do not discontinue your therapy!” The steroid injection is to aid in inflammation and pain reduction, which increases the speed of your healing time but it will not resolve your condition.

There are two common outcomes from a corticosteroid injection; either it works or it doesn’t. It’s that simple. If the pain reduces, fantastic! But do not return to get another injection thinking a little was good more will be great; continue your therapy and work to resolve the issue not to hide it. If you feel your injection is not working, give it some time (at least two weeks) before talking to your doctor about another injection and consider the benefits and side effects once again.

I hope this information has helped you in considering whether to have a corticosteroid injection or not. If you have any questions please feel free to ask me, about your condition and if you should talk to your medical doctor about a corticosteroid injection.

Nath​an T. Eldredge DC, CPE, ACN, CCWFN, FBCA


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