Large scale studies show no evidence of tissue damage from properly administered steroid injections, except for very minimal fat cell reduction at the immediate site. There is no toxicity to nerves when injected monthly at our usual doses.
Osteoporosis, always a concern in the older patient, is very much exacerbated by high dose
oral steroids. Again, the doses used in spinal injections are so tiny, relatively speaking, that no acceleration of osteoporosis is seen, even with monthly injections over the course of several years.
Steroid injections are associated with two categories of risk.
The first category of risk posed is that of trauma by the needle itself. On rare occasion, a nerve or nerve ending can be touched and mildly injured by the needle. The small nerve has a remarkable capacity to heal itself, however, within a few days to a few weeks. More commonly, the needle can cause some localized bruising/swelling of soft tissues, which results in a sore area at the injection site lasting only a few days.
The second category of risk posed is that of the steroid injected. In past years, steroid used in spinal or epidural injections have generated considerable controversy, among our orthopedic colleagues in particular. One of the main reasons we prefer to inject steroids rather than to prescribe them orally is that the injected dose is much smaller, and the body is accordingly exposed to a much lower overall amount of drug. This is because the steroid is placed exactly where needed, onto the pain generator, unlike oral steroids which are heavily diluted by the blood, requiring very high doses to be effective at the small site of pain generation. Side effects of too much steroid (weight gain, bloating, easy bruising, "tissue paper skin") are very rare with steroid injections given even on a monthly basis.
Regardless of the minimal risks from steroid injections, it is still prudent to explore other relatively simple alternatives for pain control before injected steroids are considered. However, injected steroids should nearly always be used before oral steroids whenever a specific target of the pain can be injected.
Founder and CEO, PainCare
Pain Talk Articles
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