The truth about steroids
Steroid injections are a great option for pain relief. There seems to be a common misconception that all steroids, in any form, in any dosage given for any duration, will cause unwanted complications. Nothing could be further from the truth.
There is NO danger in a properly administered steroid injection for pain relief as long as your doctor has discussed all possible risks with you and used all means possible to reduce those risks. Your doctor also looks out for your best interest in ensuring the injection is accurate by using Ultrasound guidance.
What are steroids? These compounds occur naturally in the body and are made from cholesterol. They fall into two categories: (1) Corticosteroids – cortisol and aldosterone; (2) Sex hormones – testosterone, estrogen and progesterone. The corticosteroids and small amounts of the sex hormones are made in the adrenal cortex (outer part of the adrenal gland) while most testosterone and estrogen are made in the testicles and ovaries, respectively.
Cortisol controls glucose metabolism, immune system function, cognitive factors such as attention and memory and normal development of the lungs and brain in babies in the womb. Aldosterone maintains the salt and water balance in the body and the sex hormones are necessary for reproductive function and secondary sexual characteristics.
Steroids are manufactured for medical purposes to treat persons with symptoms related to deficiency of the respective hormone. Glucocorticoids (cortisol and related compounds) are also used to treat various autoimmune and inflammatory conditions including asthma, lupus, rheumatoid arthritis and many others.
They are also used to prevent rejection after organ transplant and are commonly used to treat joint, tendon, ligament and nerve pain. Administration is usually oral but may be inhaled for asthma and topical for some skin conditions.
The possible adverse effects of steroid injections for pain include:
– Elevated blood glucose in diabetics
– Fat atrophy
– Skin hypo-pigmentation (skin in the area turns white)
– Flare reaction (sudden worsening of pain)
– Tendon rupture
Elevated blood glucose levels usually return to normal within five days. Close monitoring and possibly increased medication for a few days (under medical supervision) are usually sufficient to manage this problem if it occurs. The flare reaction can result from the crystals in the steroid and can be managed by using an anti-inflammatory medicine.
The other problems can be avoided by finding out if the patient is on any blood thinners, using sterile injection technique and ensuring accuracy. Fat pad atrophy in the heel or tendon rupture will produce more disability than what existed before the injection.
The use of Ultrasound Guidance minimizes the risk of these complications, ensures accuracy and safety and improves efficacy and possibly cost effectiveness. Unwanted systemic (throughout the body) side effects do NOT occur with a single injection but may occur if multiple injections are done over a long period.
When used orally, high doses or prolonged use increase the risk of:
– Weight gain
– Fluid retention
– Increased blood glucose
– High blood pressure
– Puffiness of the face
– Thinning of the skin
– Cataracts or glaucoma
– Mood swings
– Stomach ulcers
– Menstrual irregularities
– Buffalo hump – caused by deposition of fat in the upper back between the shoulders
– Osteoporosis (brittle bones)
Testosterone is also given to boys with delayed puberty or persons with low muscle mass due to severe illness such as cancer or AIDS. Because testosterone and other androgenic-anabolic steroids build muscle and strength, they are also used to illegally boost sporting performance.
The World Anti-Doping Agency (WADA) prohibits the use of these substances and testing positive for any of them will result in suspension from the sport.
Side effects of androgenic-anabolic steroids include:
– Bad acne
– Stunted growth and height in teens
– Altered mood, irritability or increased aggression
Women may have menstrual irregularities, deeper voice, facial hair growth and baldness. In men, long term use can shut off natural testosterone and cause shrinking of the testicles, low sperm count, infertility and breast enlargement. Heart, liver and kidney damage can occur and elevated “bad” cholesterol levels increase the risk of heart attack and stroke. Athletes and any person without a medical reason to take these compounds should stay far away from them.
Once again, there is NO danger in a properly administered steroid injection for pain relief. Remember, the steroid injection should be only one part of your treatment. Targeted exercise is crucial for your recovery and you should ensure that your doctor provides you with access to that as well.
(Dr Shane Drakes is a Specialist in Physical Medicine & Rehabilitation and Sports Medicine. He can be contacted at firstname.lastname@example.org. You can see more educational articles at www.optimalfunctions.com)
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