Corticosteroids, also known as steroids, are powerful anti-inflammatory compounds. They mimic the body’s own steroid hormones and can diminish inflammation by preventing phospholipid release and eosinophil action. In plain English, these are man-made compounds that reduce inflammation when tissue damage or irritation is occurring.
Inflammation and Pain
Many problems that cause pain are due to tissue damage or irritation, sometimes it is acute and at other times it is chronic and ongoing. Inflammation can result from any of the following:
- Degenerative changes in the spine and joints
- Disc bulges and herniation
The body can often deal with routine inflammation with its own mechanisms. The inflammation often stimulates sensory nerves and is perceived as pain.
When inflammation and pain is beyond normal control and impacts function, the use of corticosteroids is sometimes appropriate. These medicines can be given in a number of different ways. They are easily given orally and travel to everywhere in the body. Oral steroids, often prednisone or decadron, are inexpensive, and if given for a week or less have very little side effects or risk. They can often be very effective for acute or sub-acute pain in many areas of the body.
Corticosteroids are often used as injections targeted to very specific sites to treat pain caused by ongoing inflammation. Many joints, such as the knees, hips, and shoulders, can be injected to reduce pain, especially if it is just one isolated area. If multiple areas inflamed, injections are usually not used since the risk of too much steroid exposure may be a problem.
Severe spinal pain is often treated with steroid injections. The discs and spinal facet joints are deep structures with limited blood flow. The delivery of oral steroids to these regions may not be sufficient to decrease inflammation. Injection of these medications can deliver them to the specific structures that are inflamed and be maximally effective in controlling symptoms of pain for months at a time. These spine injections are best done by an experienced pain management physician and done with real time x-ray guidance to make sure they are delivered to the right spot and no other damage is done.
Since steroids can have significant side effects, and cause damage to the body if over used, the overall use must be closely monitored. Most pain physicians prefer that steroid shots be limited to 4 to 6 times in one year for safety reasons. There is not an absolute maximum and not a lifetime maximum. The risk and benefit needs to be evaluated for each individual and discussed between the patient and physician. Careful use may have a profound effect on pain control and often can be life changing in some pain patients. Since everyone is different, a pain physician can help guide a patient through a comprehensive strategy that maximally benefits each individual.
Thomas Cohn, MD
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