If you’re suffering from back pain and looking for non-surgical relief, cortisone injections may be just what the doctor ordered. This type of injection can also help other areas of pain such as leg pain or joint pain. They can reduce inflammation, pain and swelling at specific areas of your body. This includes your ankle, elbow, hip, knee, shoulder, spine and wrist and hands. Doctors often use cortisone injections for back pain to treat nerve damage in your neck and/or lower back. They can also use them to treat a condition called spinal stenosis, or a narrowing of your spine.
Let’s explore more about cortisone injections to help you decide if they are a part of a treatment plan you’d like to discuss with your healthcare team.
Cortisone injections 101
Cortisone is a corticosteroid that is injected around the nerve roots or in the epidural space can decrease swelling as well as pain. It can also reduce numbness – but not weakness – in the legs. Although it is a powerful anti-inflammatory drug that provides pain relief, current medical advice dictates that patients receive no more than 4 injections per year.
“In general, a patient shouldn’t have corticosteroid injections into any given joint more than once every three to four months,” says Jonathan Samuels, MD, assistant professor of rheumatology at New York University Langone Center for Musculoskeletal Care, New York City. “Too many injections increase the risk of side effects, such as avascular necrosis, which is the lack of blood flow to a part of the bone that causes it to collapse.
“If you did no greater than 4 injections a year in a given joint, it’s pretty safe,” says Roy Altman, MD, professor of medicine, rheumatology, at UCLA Medical Center, Los Angeles. he also notes that repeat injections tend to be less effective.
The location of the injection site is determined by your specific back condition. Someone who has sciatica, degenerative disc problems or spinal stenosis would get a cortisone shot injected into an area in the spinal column called the dura. This is the sac that encloses the spinal cord and spinal nerves.
While the idea of an injection in the spine is not appealing, the shot is not as painful as it sounds. Cortisone is often administered with a numbing medicine, like Carbocaine or Lidocaine. For women who have had epidurals in the delivery room, a cortisone injection is a piece of cake.
Why cortisone shots once had a bad rap
If the term “cortisone shot” carries a negative connotation in your mind, you’re not alone. Cortisone injections, also known as epidural steroid injections (ESIs) were first administered to people suffering from sciatica and lower back pain in 1952. At the time, it was the quickest way to combat back pain temporarily without surgery.
Problems with cortisone shots were not uncommon. Some of the issues were due to the amount of cortisone administered. Other issues arose based on the injection being given in the wrong spot or the individual’s health not being fully assessed.
Even today there are people who view cortisone injections for back pain to be controversial. Some patients experience what is referred to as a “cortisone flare” after getting an injection. This flare is often painful – sometimes even more so than the back pain that is being treated. However, that flare is temporary. The injection is still effective in providing pain relief.
Cortisone injections can also weaken tendons, which is another point of controversy surrounding the treatment. For this reason, injections can never be made directly into the tendons to avoid the risk of patients developing tendinosis or tendinopathy.
Remember: these are not anabolic steroids like what weight lifters or athletes use to bulk up. Steroids are used differently in medical practice.
It’s a short-term fix
While steroid shots may give you temporary relief from back pain, remember that:
- They aren’t a cure-all for your back condition
- If you’re struggling with pain that radiates down your leg, a cortisone shot could give you the relief you need to start physical therapy
- For others, your chronic back condition may improve while you’re pain-free from the cortisone
- Cortisone is only treating your symptoms, not the cause
“You would do less invasive, less aggressive things first,” says Dr. Robert Shmerling, an associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.
Effective relief for back pain
Today’s medical standards rely on cortisone injections to help people who live with chronic back pain. Cortisone injections for back pain may provide you with pain relief long enough so that your back injury can heal. This can allow you to move forward with other treatments such as an exercise program or physical therapy to regain movement and strength.
The verdict on cortisone shots
Trying a cortisone injection to temporarily alleviate your back pain is your personal decision. Living with chronic pain is miserable. If you need relief, consider this a safe solution to try. Talk to your trusted medical professional about your interest in this treatment.
The effects of a cortisone shot can make your journey to improved spine health more comfortable for a while. Remember though that the real healing will begin when you can make physical changes that include muscle balance and proper alignment of your spine.
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This post has been updated as of December 2018 with new information and resources.