Steroid Injection Risks: STOP INJECTING PATIENTS WITH STEROIDS!!!

by Chris Centeno, MD /

steroid injection risks

I love blogging about my experiences in clinic, especially the ones that make my blood boil. One of those blood boiling issues is steroid injection risks. This past week, while seeing patients at our licensed, advanced stem-cell-culture site in Grand Cayman, I saw a guy whose hip MRI from December wasn’t that bad. In fact, it didn’t fit with his quickly declining function and elevating pain. A quick preprocedure X-ray confirmed what I had feared—two steroid shots he had in that hip a few months back had accelerated his arthritis like pouring gasoline on a bonfire. So this post is aimed squarely at the legions of physicians who continue to use steroids…

Steroid Injection Risks Are Nasty

Physicians around the country inject high-dose corticosteroids in joints like it’s holy water. The dose they use is based more on medical tradition than on science. You see, while the milligram-dose range used sounds small (after all, it’s only a thousandth of a gram), to the body it’s massive. In fact, it’s a million times too much as the joint and cells of the body are used to seeing a billionth of grams (nanograms).

What happens when you dramatically overdose tissues used to seeing nanograms of steroid with milligrams? Bad stuff!

Just take a look at some of those effects from using a large dose of steroids. Metabolic of hormonal changes. Increased risk of bone fractures. Increased risk of serious bone disease. That’s stuff your doctor probably doesn’t talk about when offering you steroid injections. Even when avoiding the worst case scenarios, patients still might have to deal with other steroid injection side effects like pain and swelling or skin discoloration. Patients may even experience side effects like headaches, dizziness, and insomnia in reaction to a steroid shot.

Why, Then, Are We Still Injecting Patients with High-Dose Steroids?

Steroids are an inconvenient truth. That temporary relief people feel won’t last for long. They can make a patient feel better for a while, but they also likely cause more long-term harm than good. So why do we use them? Why do so many favor a short term benefit that leads to much more serious long-term problems? First, many physicians don’t have anything better to offer. Let’s be honest here. In a world where regenerative-medicine solutions are exploding, that’s just a simple lack of imagination and knowledge on the part of the physician. Second, they’re covered by insurance, and many physicians have a hard time thinking outside of the insurance box, even if what’s in that box is not in the best interest of the patient.

How We Can Keep Our Insurance Overlords Happy and Help the Patient

When we first began using stem cells in 2005, the research was clear that nanogram-dose (ultra-low-dose) steroids was what the body was meant to experience. Meaning when you look at in vitro studies where cells are exposed to corticosteroids, the appropriate dose range to get an effect is in the tens- to hundreds-of-nanogram range. This is more than enough to activate receptors. In fact, steroids in this dose range can do some cool things, but steroids in the much higher milligram-dose range (one million times more) kill cells. Hence, the solution would seem to be simple: given the steroid injection risks, if you have to use steroids, why not just use them in the appropriate dose range for the body?

We’ve been using nanogram steroids for a decade now, and I can tell you that they work very similarly to their bigger milligram-dose cousin. You observe the same suppression of inflammation, and you’re not killing cells. In fact the only time I’ve seen them not work is in a patient with severe inflammation due to a systemic disease or in a patient whose body has gotten used to the sledgehammer effects of high-dose steroids.

The upshot? Ladies and gentleman, madams and monsieurs…it’s time to ditch the high-dose steroids! Going with the proper dose is an easy solution to a problem that we shouldn’t be having. Just use the low dose version to protect your patients! It’s just as effective, and it’s backed up by science as well!

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30 thoughts on “Steroid Injection Risks: STOP INJECTING PATIENTS WITH STEROIDS!!!

  1. stef

    Merci pour le français mais c’est mesdames et messieurs (pluriel). BTW coming to Montréal anytime soon ?

    1. Regenexx Team Post author

      Stef,

      Pas de nouvelles o ce front , mais nous promettons que vous serez le premier à savoir !

  2. Jill freyensee

    This makes total sense to me! I’ve been getting steroid injections for years due to my knee issues. They don’t even work anymore in fact I had a euflexxa injection, it was supposed to be 1 out of 3 when they first came out when they used chicken combs and had a massive reaction where my entire leg swelled and I couldn’t walk for a week. Needless to say I didn’t finish that series. Since then I’ve had multiple injections of other steroids. 18 months ago I still had cartilage in my knees, not much but some. I just had 3 MRIs 2 months ago and have NO cartilage left, which I was left with the option of you guessed it… A 35 year old with partial knee replacements. I am not overweight at 5’6″ 130lbs and am very active so I shouldn’t have declined so rapidly. I haven’t done replacements for one I’m 35 and two bc I saw your postings and now know what I want to try. Of course, that takes $ that I have to make, but hopefully in time I will be able to have stem cell injections and not be on pain pills as I am a nurse and have to grin and bare it through a 12 HR shift without my pain meds.

    1. Regenexx Team Post author

      Jill,

      So sorry to hear that! But unfortunately it is a troublingly familiar story. Avoiding a knee replacement at 35 is a very wise decision! This is an important read and includes supplements which have been found helpful in the “Supplement” section: http://www.regenexx.com/blog/knee-replacement-questions/

  3. Christine Smock

    I KNEW IT!!! Last January I was evaluated by a PA at Kaiser who said I had mild arthritis in both hips. He recommended a steroid injection to help with the pain. I got it in my right hip and it felt great for a week. Then the pain returned but it was twice as bad. So bad I’ve had to walk with a cane for the last 7 months. It hasn’t gotten much better despite physical therapy and regular water aerobics. A recent MRI indicated I now have moderate to severe arthritis in the hip that was injected…how did I go from mild to severe arthritis in 7 months? When I’ve asked the medical people involved with this if maybe the steroid had made things worse for me they play dumb and act as if I’m loony for suggesting it. I’ve just had PRP and hope I’ll see some improvement. JUST SAY NO TO STEROID INJECTIONS!

    1. Regenexx Team Post author

      Christine,
      We post the dangers of Steroid Injections both for patients and the Doctors giving them. The research is clear and echoes what we see repeatedly in clinic. Hoping the PRP helps as well. If not being treated early with stem cells would be important as unlike other joints, Hip arthritis escalates very quickly, and early intervention is important: Please see: http://www.regenexx.com/blog/new-research-knee-and-hip-oa-are-different/

  4. Jacqueline Schneider

    Epidural Steroid Injections are the number one cause of Spinal Arachnoiditis. I know because I have it!!! How can physicians keep injecting this poison into our bodies even know the FDA has a warning on the box stating that it is NOT to be use in the spine???

    1. Chris Centeno Post author

      Jacqueline, I think these are still used based on insurance coverage and the fact that it’s tradition.

  5. Lynn Cole

    I have a suspicion, after reading many of your notes on injectable steroids, that I seem to have developed a type of “tendonitis” in my upper arms due to multiple elbow steroid injections. I have had 4 in my left elbow (worst arm) and 2 in my right, about 5yrs ago. I have been having this tendon problem for about one year now, and not one doctor can figure out what’s wrong. One actually said “it seems like tendonitis”, but no cause or cure was suggested. The steroid injections is the only common denominator here. The right arm is affected as well, but not nearly to the degree of the left (and I’m right handed, so maybe the strong arm is less affected, plus I only had 2 injections there). Is there hope for acute tendonitis in my bicep/tricep area?

    1. Regenexx Team Post author

      Lynn,
      Yes, there is definitely hope. Do you have a recent MRI?

      1. Lynn Cole

        I do not have MRI’s for my arms. I have had every other test known to man but nobody thought an MRI was appropriate for the “problem”…..which by the way, they couldn’t figure out. I live in the Detroit area, is there a clinic nearby to visit?

        1. Regenexx Team Post author

          Lynn,

          Relatively close. Here’s the Interactive of Regenexx Physicians list, so that you can find what works best for you. Please see: https://regenexx.com/find-a-physician/

  6. Robert Ritchey

    You post an isolated incident… what about the millions of people who continue to have a reasonable quality of life with steroid injections. Until a reasonable, affordable alternative is found, this is one of our best options. Like it or not, our options are limited. With that said, I do respect the work you are doing and look forward to seeing your successes in the future.

    1. Regenexx Team Post author

      Thanks Robert. We see this in clinic all the time. Our problem with steroid shots is the damage they do to patient’s joints. They breakdown cartilage, can damage tendons and they’re lethal to the stem cells living in the joints. When possible, hylauronic acid (Supratz, Synvisc, etc.) which is basically a lubricant and does no damage can often help for a few months at a time. Many people find Curcumin helpful for pain and inflammation. Please see: https://regenexx.com/blog/does-curcumin-work/

  7. Cyndi

    Was glad to find this article when researching dangers of cortisone injections in joints. I worked with thoroughbred race horses for 15 years and saw the damage to their joints over time with cortisone injections. Their joints seemed to become much more painful (breakdown of cartilage) over time until finally they’d be retired if worth anything as a stud or put down if no rescue organization stepped in.

    I’ve been anti-steroids (both oral or injections) all my adult life. I can’t imagine anything good coming from suppressing our immune systems.

    I’ve recently been diagnosed with osteoarthristis, and psuedo-gout. I went to get a Supartz injection (the most painful thing I’ve ever experienced) and specifically told the doctor no cortisone. Of course when I asked for a copy of my medical record, he had indeed injected cortisone in my knee.

    I see a Rheumatologist tomorrow and all my research on pseudo-gout says cortisone injections for the pain. I’m gathering facts to present as to why cortisone injections are dangerous and I refuse that procedure so they don’t just call me a kooky senior.

    Thank you for this article so I can provide documentation to the doctor. My comparison to the damage I’ve seen cortisone injections cause in racehorse never seems to get the point across, but I’ll go in armed with what I’ve learned from this article. And I see you have a clinic in Chicago. Do they treat osteo arthritis and pseudo-gout?

    1. Regenexx Team Post author

      Cyndi,

      Glad the article was helpful! Yes, Chicago Arthritis would be a good fit. Here’s their website: http://www.chicagoarthritis.com

  8. Jessie Hill

    I have had 5 shots for my spinal stenosis and the shots help some. I realize how much when they wear off. I am afraid of steroids but the pain sends me to the Doctor everytime. If not steroid shots what other options are there? I do excerises that I was taught in therapy. I try not to do anything to stress my back. The pain is only relieved by sitting in my chair and that is not good for me or healthy at all.

    1. Regenexx Team Post author

      Jessie,
      Steroids are a net negative. Platelet Lysate, and in some very specific circumstances, stem cells, both from the patient’s own body are regenerative. Please see: https://regenexx.com/the-regenexx-procedures/back-surgery-alternative/

  9. Nadine

    Hi, this is interesting! I had a steroid injection into my shoulder joint about 3 months ago and I’ve been so unwell ever since with all sorts of hormonal problems that no one can get to the bottom of. Can I ask what you mean by the cortisol -pituatry axis? When I googled my symptoms it takes me to Cushing’s syndrome, which talks about cortisol. Any help/advice be great x

    1. Regenexx Team Post author

      Nadine,
      We wouldn’t be able to advise without examining you, but in this case, this is out of our field. An endocrinologist, or functional medicine physician may be able to help. This explains the cortisol pituitary axis issue: https://regenexx.com/blog/more-evidence-mounts-that-steroid-epidural-injections-have-significant-side-effects/

  10. Kevin

    Went to my doctor because of numbness in my fingertips and soreness in my hands and tendons in my forearms he dismissed every symptom I told him did a couple of quick test and told me that I had classic signs of carpal tunnel he asked me if I would like a steroid shot in my wrist and I said I don’t know you’re the doctor he basically eventually convince me to get the shot he didn’t tell me any of the risk involved the spot where he gave me the shot in my wrist I was in excruciating pain for a day and a half I looked it up and I guess I had a cortisone flare he recommended maybe I take some time off work and quit some of my activities off work now he’s denying that he said to take time off work I think I need to go get a second opinion

    1. Regenexx Team

      Hi Kevin,
      Agree! We treat Carpal Tunnel Syndrome regularly. Please see: https://regenexx.com/conditions-treated/hand-and-wrist/carpal-tunnel-syndrome/ This is a very similar procedure: https://regenexx.com/blog/thumb-pain-and-dysfunction-thumb-mobility-without-surgery/ To see if you would be a Candidate, please submit the Candidate form here: http://www.regenexx.com, or give us a call at 855 622 7838 for assistance with that process, or to set up an exam.

  11. Stacey

    I was just told that I need neck surgery and I have had Multiple injections in my neck and back that didn’t work. I went to my neurologist and was told I need a fusion and pins and plates in my neck

    1. Regenexx Team

      Hi Stacey,
      While often giving temporary relief, Cortisone injections escalate the situation by breaking down tissue. Most importantly, accurate diagnosis which requires both imaging and a thorough exam, is critical in making treatment decisions. Please see: https://regenexx.com/blog/want-see-advanced-image-guided-injection-step-procedure-suite-dr-pitts/ and https://regenexx.com/blog/active-grandmothers-neck-pain-resolved-without-surgery/ and ://www.regenexx.com/conditions-treated/spine/neck-pain/ and https://regenexx.com/resources/videos/ and https://regenexx.com/resources/videos/spine-101-/ We’d need more information through the Candidacy process to see if we can help. To do that, please submit the candidate form here: http://www.regenexx.com, or give us a call at 855 622 7838

  12. Robert Soliz

    Hi, I have never taken cortisone injections or have taken any kind of medication for pain or any injury. I did get a respiratory infection where my tonsils had swollen up and could hardly breathe and was given a steroid shot in the leg and was given prednisone a Zpack to take. I took the prednisone as prescribed and on the last day taking it, the night after that day I woke up in the middle of the night to use the restroom and was not able to walk. I had lost all the strength in bot my legs. I had to hold on everything just to get to the restroom. the second day I was able to walk but was every weak. It took about three days to feel normal. I called my PCP that gave me the medication and asked what had happened. He was not in the office and the nurse stated that muscle loss was one of the side effects and not to worry. After some time, not remembering how long. I started to have hip pain on my left hip after sitting for a long period of time. I finally went to my PCP to get checked and he figured I had tore a muscle and referred me to an Orthopedic Dr to get checked and the Orthopedic Dr schedule an MRI because he believe with the weakness in my muscles in my left leg that I definitely tore a muscle. I told him I was not that active and don’t remember doing anything where I could have torn it. After the MRI he concluded I had Bilateral Avascular Necrosis and could not figure why this had happened. He said he checked everything he could and made no connection. Since he caught is early he recommended Core Decompression to both hips one after the other as soon as one hip had recovered. That was not a good 6 months, in bed and recovering was not fun. with that surgery he put to arthroscopy incisions on both hips to do the surgery successfully. All worked just fine but I still have pain from the Arthroscopy incisions and trouble bend down.

    1. Regenexx Team

      Hi Robert,
      So sorry to hear that – wish you had contacted us as we treat Hip AVN without surgery, but thankful you are feeling better! Please see: https://regenexx.com/resources/videos/hip-avascular-necrosis-stem-cell-treatment-at-regenexx/

  13. Annie

    NEVER ALLOW YOUR DOC TO GIVE YOU STEROID INJECTION!
    I was given a steroid injection 6 weeks ago, became ill immediately, now dealing with weakness and aching legs, constant exhaustion, headaches and feel a need to stay in bed.
    I’m a very active person. Was working out in my gym the day prior to the injection and feeling fine.
    I’m praying this decline in health is not permanent!
    I’m not able to walk very far.
    As I write this my legs are aching all over.

    1. Regenexx Team

      Hi Annie,
      Where was the steroid injection?

  14. Cynthia Soma-Hernandez

    Is this stem cell procedure covered?

    1. Regenexx Team

      Hi Cynthia,
      Yes, for approximately 7 million people, which is the very first stem cell procedure coverage. Here you’ll find more details and some of the companies providing Regenexx coverage: https://regenexx.com/blog/stem-cell-procedure-insurance-coverage/ If you don’t have this coverage, you may want to share this link with your Employer as it may be great cost saving for them: https://regenexxcorporate.com/ If your current insurance is in Network, the extensive exam which very valuable in of itself ( https://regenexx.com/our-approach/regenexx-sans-evaluations/ and https://regenexx.com/blog/hip-replacement-pain/ and https://regenexx.com/blog/chronic-knee-replacement-pain-2/ ) is usually covered. Please call 855 622 7838 to see what would be covered in your case.

Chris Centeno, MD

Regenexx Founder

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.
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