Issue 20.15
One of the most common questions and concerns which we encounter in our pain management practice are concerning steroid medications. The word “steroid” has a variety of meanings and subsequently is commonly misunderstood. Because of this confusion, many people perceive steroid medications to be very dangerous and are extremely reluctant to consider this medication as a viable treatment option. This article is designed to help clarify this issue and maybe even dispel some commonly held myths.
It is important to make several distinctions. There is a big difference between steroids used for legitimate medical reasons and anabolic steroids which are used by some athletes and bodybuilders to build muscle and enhance performance. Anabolic steroids are very controversial and can potentially be very dangerous. Steroids that are used for medications are called corticosteroids, and are the same thing as cortisone. We commonly use the terms cortisone and steroid interchangeably. Historically, this class of medications has primarily been used to provide a potent anti inflammatory benefit to treat conditions such as asthma, arthritis, and allergies, just to name a few. Cortisone medications are available in a variety of formulations, including oral, injectable, and topical. Steroid medications began to be heavily prescribed in the sixties and seventies, primarily because they provided profound improvement of symptoms compared to previous available medications. Unfortunately, it was eventually discovered that they also had the potential of causing a wide variety of side effects, some mild and some severe. Serious side effects typically occur when patients are on high doses steroids for extended periods of time. These side effects include osteoporosis, immune dysfunction, and weight gain. Because steroid medications were so popular initially, and physicians truly didn’t understand all long term implications, it is likely that they were over prescribed and patients on long term treatment began to experience these negative side effects. Because of this history, we now have a much better understanding about potential side effects and subsequently are much more careful about the amount of steroid medication that can be safely administered.
In our specialty of pain management we use steroid medications for many of the injections which we utilize to treat neck, spine and joint pain. We are able to deliver this medication exactly to the affected area with the goal to quickly reduce swelling and inflammation and subsequently pain. Despite the highly effective nature of steroid injections, we certainly acknowledge the potential side effects which I have discussed. In our office, we have developed strict protocols regarding the limit of medicine that can be safely injected per year. By doing so, we generally can avoid the serious, long term complications which can occur.
Steroid medications also have the potential to cause mild and usually short lived sided effects. These may include skin rashes, facial flushing, insomnia, headaches and a jittery feeling. These probably occur less than twenty percent and typically subside within five days or less. Incidentally, weight gain is rarely seen with injections spaced properly apart. When weight gain does occur, it is typically very mild and usually resolves quickly. Potential side effects are always discussed prior to any steroid treatment. As part of this discussion, the risk and benefit of these medications are carefully weighed. We typically recommend the most conservative treatment option with the safest side effect profile to mitigate any potential risk. We also seriously consider overall health status, immune function, and current medications before recommending steroid injections.
Our primary goal with steroid medications is to use just enough medicine to achieve the desired affect with also minimizing possible complications. This is something we take seriously, because in addition to wanting to decrease pain, we certainly don’t want to jeopardize our patient’s health.
By Mark Udy can be contacted at Desert Pain Specialists in St. George, Utah. (435) 216-7000.