Steroid injections - They don't cure your problem!

People who are experiencing extremes amount of pain may often look for a solution to help eradicate their pain. Many will seek a cortico-steroid injection or steroid injection for short. Here we will try and explain why we are not avid fans of the steroid injection. Steroid injections can only be administered by advanced practitioners, including specially trained physiotherapists. Whilst I am not qualified to administer steroid injections, I have little interest in learning how to administer them, equally I am reticent to refer to qualified professionals to administer them. Here are some of the reasons why. 1. There's no guarantee they'll ease your pain!

Whilst they are effective in giving pain relief, there is no guarantee! Depending on which literature you choose to read and which joint has been injected, on average they are just over 50% effective. These effects reduce over the medium and long term.

NICE guidelines are also suggesting they are not used in the management of pain relief is some parts of the body already. The low back and knee are rarely to ever injected for pain management. There is increasing evidence that other joints like the hip and the shoulder do not have a primary inflammatory problem and injections are becoming fewer and fewer in these joints too. Studies have been conducted comparing steroid injections and placebo injections. The results have shown minimal to no significant difference in effect. 2. They come with a risk!

Although rare, there is always a risk. And if there is a chance of a risk, those risks have to be explained. Some of the risks of repeated and long term steroid usage is:

• Pain and discomfort for a few days.

• Temporary bruising or a collection of blood under the skin.

• Flushing of the face for a few hours.

• An infection, causing redness, swelling and pain – get medical advice as soon as possible if you have these symptoms.

• A loss of fat where the injection was given – this can cause dimples in the skin and may be permanent.

• Paler skin around the site of the injection – this may be permanent.

• If you have diabetes, your blood sugar level may go up for a few days.

• If you have high blood pressure, your blood pressure may go up for a few days for a few days.

Less common side effects can include:

• allergic reactions,

• insomnia,

• mood swings,

• headache,

• euphoria,

• vertigo,

• dizziness,

• nausea,

• bloating,

• appetite changes,

• stomach or side pain and stomach upset,

• acne,

• a wound that is slow to heal,

• thinning hair

• sweating more than usual,

• irregular menstrual periods,

• weight gain

• bone density loss or osteoporosis

• weakening of the immune system,

3. They come with additional precautions and contra-indications.

If the risks are not lengthy enough, there are a list of conditions you may be in or have, that would mean a steroid injection could not be administered. These are:

• Having had a steroid injection in the last 6 weeks

• You've had three steroid injections in the last year

• Having had an allergic reaction to steroids in the past

• Have an infection (including eye infections)

• Having recently had, or are about to have, any vaccinations

• Pregnant, breastfeeding or trying for a baby

• Having any other conditions, such as poorly controlled diabetes, epilepsy, high blood pressure, or problems with your liver, heart or kidneys

• Taking other medicines, such as anticoagulants (blood thinners)

4. They are a pain relief - not a cure!

People who have a successful steroid injection, feel the problem is cured. Except this could not be further from the truth. A steroid injection can help bring the pain under control. Once someone has had a steroid injection, the usual pathway is to undergo a course of physiotherapy to provide appropriate corrective and strengthening exercises to cure the problem.

Anecdotally, people who have had a successful steroid injection do not adhere to the exercise program because they cannot feel the pain. Once the injection has worn off, they tend to return for another injection. It is this that increases the risk of the risks above. However Steroid injections have their place in current medicine and pain management. If someone has tried to manage their pain with oral pain relief like paracetamol and therapeutic-thermal techniques, like heat to no effect, then a steroid injection is sometimes necessary and beneficial for a part of the population in order to perform corrective exercise. In consideration, I would always suggest that people considering a steroid injection as a form of passive treatment consider the benefits versus the potential long term risks. Whilst I maybe reticent to refer to a colleague who can inject, I have referred clients who have tried to manage their pain with pain relief and thermal techniques and are aware of the risks.