Most likely, you or someone you know, has received a steroid injection for joint or muscle pain at the recommendation of a health professional.

But steroid injections are an inconvenient truth…

The use of steroid injections as anti-inflammatory orthopedic treatment solutions began in the late 1940s. They were revered for providing immediate short-term pain relief and facilitating increased range of motion, but contemporary studies have since exposed their adverse long-term effects. In this blog post, we delve into the research highlighting these negative effects, so you can make an informed and fair decision to manage your pain.

Are doctors giving the correct dosage?

Waterfall

Physicians around the country inject high-dose corticosteroids into joints like it’s holy water. But while the milligram-dose range used sounds small (after all, it’s only a thousandth of a gram), to the body it’s massive. In fact, it’s a million times too much, as the joint and cells of the body are used to seeing a billionth of grams (nanograms).

When Regenexx first began using stem cells in 2005, the research was clear that nanogram-dose (ultra-low-dose) steroids was what the body was meant to experience. This is more than enough to activate receptors. In fact, steroids in this dose range can do some interesting things, but steroids in the milligram-dose range (one million times more) kill cells. Hence, the solution would seem to be simple: given the steroid injection risks, if you must use steroids, why not use them in the appropriate dose range for the body? You observe the same suppression of inflammation, and you’re not killing cells.

Are steroid injections simply a placebo?

The Placebo Effect

The placebo effect is essentially a positive health outcome triggered by a patient’s anticipation that a prescribed treatment or medicine will help them. From a number of clinical trials, it seems that steroid injections often underperform, even when compared to administered placebos.

For example, a two-year randomized clinical trial of 140 patients with knee osteoarthritis, compared steroid injections versus placebo saline injections, and demonstrated a significantly greater cartilage volume loss, with no effect on pain, for patients who received the steroid injections.[1] Results of another clinical trial of over 2,500 patients demonstrated consistent long-term and intermediate symptom exacerbation from steroid injections; in some cases even the short-term injection was no more effective than the placebo.[2] And finally, another clinical trial of 165 patients examined the use of corticosteroid injection versus placebo injection for the treatment of tennis elbow, and showed worse clinical outcomes one-year post corticosteroid injection.[3]

A randomized controlled trial in the Journal of American Medical Association also concluded there was no benefit of corticosteroid injections for knee osteoarthritis. [4]

So, what are the risks and complications of steroid injections?

  • A four-year study of over 1,500 patients who received local corticosteroid injections revealed a 40% procedure error rate, resulting in an identified complication rate of 18%, including both septic and aseptic complications.[5]
  • According to the North American Spine Society’s clinical review of over 6,000 patients, a single epidural steroid injection can increase the risk of spinal fracture by 29%.[6]
  • In a study examining osteoarthritis and hip surgery results, patients who received a steroid injection within one year proceeding hip surgery were at a 37% increased risk of surgical infection, and a 53% increased likelihood of needing an additional hip replacement surgery within two years of their original surgery.[7]
  • Cervical epidural injections risks include “epidural hematomas, infection, inadvertent intramedullary cord injections or cord, brain stem, and cerebellar strokes.”[8]
  • Traditional steroids are toxic to mesenchymal stem cells. For example, two commonly used steroids in orthopedics, at just 25% and 75% of the usual clinical dose wiped out all mesenchymal stem cells.[9]

What are the chances of recovery with steroid injections?

Covering up with a bandaid

Steroid injections might be covered by insurance, but many physicians have a hard time thinking outside of the insurance box, even if what’s in that box is not in the best interest of the patient. In the short term, the steroid injection can provide temporary pain relief, but it comes with the caveat of obstructed long-term injury recovery.

On average, patients who received steroid injections have a lower overall rate of full injury recovery[10]. In comparison to individuals who choose to wait for their injury to resolve over time, a steroid injection makes you 63% more likely to have a subsequent injury relapse. (So, it appears that doing nothing is more valuable for your health than a steroid injection.)[11]

Repeat steroid injections have also been linked to the deterioration of cartilage. Following a scientific study of horses who received repetitive intra-articular administration of steroids, test subjects showed very early cartilage degeneration.[12]

Steroid injections are catabolic, meaning they are destructive to your cell and tissue health rather than supportive. Unfortunately, they are a widely used and requested due to convincing and rapid pain relief. However, any short-term reprieve is overshadowed by the toxic long-term side effects.

 

Originally published on Regenexx.com, written by Dr Centeno.

Further Reading – Original blog posts:

https://regenexx.com/blog/new-research-steroids-hammer-stem-cells/

https://regenexx.com/blog/steroid-injection-risks/

 

Notes:

[1] https://jamanetwork.com/journals/jama/fullarticle/2626573

[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61160-9/fulltext

[3] https://jamanetwork.com/journals/jama/fullarticle/1568252?link=xref

[4] https://www.bmj.com/content/357/bmj.j2386.full

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394381/

[6]https://regenexx.com/blog/epidurals-steroid-shots-increase-spinal-fracture-risk-in-one-study/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926212/

[8] https://regenexx.com/blog/hip-arthritis-steroid-shots/

[9] https://www.ncbi.nlm.nih.gov/pubmed/25187334

[10] https://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/

[11] https://well.blogs.nytimes.com/2010/10/27/do-cortisone-shots-actually-make-things-worse/

[12] https://www.ncbi.nlm.nih.gov/pubmed/9692065