A New and Research-Based Corticosteroid Consent Form

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Since the research continues to mount showing that the high-dose corticosteroids physicians inject every day into the spine and joints can and do cause harmful side effects, I recently mentioned on LinkedIn that malpractice could soon be an issue. Meaning that the side effects of steroids are so bad, that at the very least, we need a new consent form to keep the attorneys at bay. While my clinic doesn’t routinely use high-dose steroid shots anymore for pain relief, if your clinic does, then here’s your new and research-based consent form:

Your doctor wants to inject high-dose corticosteroids. These are drugs that can suppress or reduce inflammation (swelling and pain). While your body may experience low doses of these drugs naturally, the amount your doctor wants to inject is much, much higher. For example, if the height of a matchbook represents the amount usually seen by your cells, your doctor wants to inject an amount equivalent to the height of the Empire State Building.

In order to proceed with this care, you must initial each section below and acknowledge that this corticosteroid injection may have the following effects on your body:

__Increased blood sugars and disruption of the hormonal system that controls blood sugar, stress, and sleep. If you are prediabetic or diabetic, you will need to either inform your physician who manages that issue or more closely monitor your blood sugars. 

__If female and older, each epidural (spine) steroid injection may increase your lifetime fracture risk by approximately one-third. This means that a three-injection series will roughly double your risk of a fracture due to osteoporosis. If such a fracture does occur, depending on your age and overall health, you may require surgery or extensive periods of inactivity, which may increase your risks for other health conditions.

__If injected in a joint, the anesthetics we use (bupivacaine or lidocaine) have been shown to be toxic to cartilage, and bupivacaine has been the subject of various lawsuits involving cartilage damage.

__If injected into your spine (epidural), steroids and anesthetics can cause the local cells to have problems.

__If injected into a joint, steroids have also been shown to be toxic to cartilage cells, and if used with bupivacaine (a common practice), it has been shown to be synergistic in the destruction of cartilage.

__If injected into a joint, research has shown that the steroids will damage your local stem cell population that is responsible for maintaining joint health (mesenchymal stem cells).

__If being used to treat tennis elbow or other tendinitis, studies have shown that while steroid shots may help temporarily, your pain will return worse than before the injection. In addition, local skin discoloration and loss of local fat are not uncommon. Finally, damage to these tendon cells is likely. 

__Your risk for a terrible bone disease known as avascular necrosis or osteonecrosis will be increased in direct proportion to the amount of steroids you are given. For example, your risk is highest with steroid pills taken by mouth. The longer you take the pills, the higher your risk. This risk likely also translates to steroid shots, in that it is likely higher with five shots than it is with one. If you contract this disease, it’s most likely you will need a rapid joint replacement, most likely your hip (but other joints may also be impacted).

__While rare, some patients have reported cushingoid features after a short course of steroid injections. This means that you may experience rapid, uncontrolled weight gain where your face will take on the appearance of the shape of a ball. The treatment for this condition can either be to stop steroid injections with the resolution of the issues or, in some cases, some of these changes may be permanent.

Please date and sign your name below to acknowledge that you have read and understood each initialed area above and have had an opportunity to ask questions and that all such questions were answered to your satisfaction. 

Name:______________________________   Date:_____________

The upshot? If your practice wants to continue to use high-dose steroids routinely in patients, no worries. Just make sure you have your patients read and sign this handy consent form. Some may decide not to proceed, but for the ones that do, at least they’ve been warned!

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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