I see many patients eager to treat their painful joints with regional steroid injections. I urge them to weigh the risks and benefits carefully. Like all things in medicine, one size does not fit all, and alternatives to mainstream treatments are often safer and more effective in the long run.
Below, I’ll explain how regional steroid injections work, why doctors use them, why they’re not my first treatment choice, and what alternatives I recommend.
What Is a Regional Steroid Injection?
Corticosteroids, also called glucocorticoids, are injected directly into a specific affected area of the body to reduce local inflammation and relieve pain. Examples include shoulder and knee joints or the epidural space surrounding the nerves in the neck and back.
These injections’ effects are variable, ranging from no response to pain relief lasting from a few weeks to a few months.
Why Doctors Administer Steroid Injections
Administering a glucocorticoid regionally (as opposed to orally or injecting it into the bloodstream) exposes only a small part of the body to the drug and reduces, but does not eliminate, the risk of system-wide side effects. However, even local side effects are possible.
The most common side effects that can occur at the injection site include:
- Hypopigmentation (loss of pigmentation)
- Joint infection because of reduced immune function
- Worsening of the adjacent bone’s integrity
- Atrophy (weakening of tendons, ligaments, and muscle in the region)
Can Local Steroid Injections Affect the Entire Body?
Yes, depending on the individual and the amount and type of glucocorticoid injected.
Glucocorticoids are a double-edged sword. They relieve pain, but they have a long list of detrimental side effects throughout the body. These include:
- Osteoporosis
- Glaucoma
- Elevated blood sugar
- Anxiety
- Insomnia
- Immune suppression
- Cataracts
- Obesity
- Diabetes
- Hypertension
These side effects could occur in the short term or long term, depending on the amount of drug injected and the exposure duration. The fewer glucocorticoids you expose your body to, the better.
Some demographics are at a higher risk of experiencing these side effects, including:
- Children — steroids can stunt growth
- People with osteoporosis — steroids can exacerbate the disease
- Women who are pregnant or breastfeeding — drugs can pass to the fetus
- Athletes — steroids injected near tendons or ligaments can increase the risk of rupture
- People with diabetes — steroids can cause sudden, extreme blood sugar spikes
- People with compromised immune systems — steroids can further compromise the immune response
- People prone to neuropsychiatric side effects (i.e., anxiety) — steroids can produce an acute anxiety response
There’s a movement afoot within the medical community to reformulate glucocorticoids so that they absorb more slowly. This would have two benefits:
- It keeps the drug in the joint longer, extending its effects (inflammation reduction and pain control).
- It’s a lower dosage, providing longer-lasting effects with less drug absorbed into the body.
Are There Alternatives to Steroid Injections?
Steroid injections are a Faustian bargain.
If you’re unfamiliar with the reference, Dr. Faustus is a character from a medieval German play. In the play, he trades his soul to the devil for unlimited knowledge.
Steroid injections may not be as malicious as the devil himself, but the trade for pain-free joints is risky.
If the risks aren’t worth it to you, you have a wide range of alternative solutions to choose from. I recommend the following:
- Topical NSAIDs (including diclofenac)
- Non-pharmacological remedies
- Resting the joint
- Physical therapy
- Massage
- Chiropractic care
- Acupuncture
Today’s Takeaways
I’m not a fan of steroid injections. They present a considerable amount of risk for the benefit they offer. Alternative treatments may provide benefits with far less risk.
Talk with your doctor, consider the risks, and explore all the options before choosing a safe route to healing.
