Exploring Steroid Injections And Side Effect Management
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Physicians have used steroid injections for years to help manage joint pain and inflammation. Many insurance plans cover these injections, but repeated use may pose risks.
Epidural steroid injections may seem like a good non-surgical option for managing pain and inflammation. However, further evaluation reveals important considerations. The first injection may provide temporary relief, but its effectiveness often decreases with repeated use.
The video above explores theories on why pain relief may decline over time with repeated epidural steroid injections. The sections below examine common symptoms linked to these injections and alternative approaches that may help support pain management.
What Are Steroid Shots?
Physicians commonly use steroid injections to help manage joint pain caused by arthritis or tendinopathy, such as tennis elbow or rotator cuff-related shoulder pain. These injections contain high doses of corticosteroids, which are similar to substances the body naturally produces to help regulate inflammation, but in much smaller amounts.
Injections deliver corticosteroids in significantly larger doses than what the body typically produces, which may lead to potential complications. Common corticosteroids used in these injections include Depo-Medrol, betamethasone, dexamethasone, triamcinolone, methylprednisolone, Celestone, and Kenalog.
How Epidural Steroid Injections Offer Diminishing Pain Relief Over Time
Many individuals who receive multiple epidural steroid injections find that while the first may provide significant pain relief, later injections often offer less benefit. This may be due to high-dose corticosteroids and certain anesthetics affecting nearby regenerative cells involved in tissue repair and maintenance.
Lumbar radiculopathy, commonly known as sciatica, develops when a spinal nerve becomes irritated, often due to a herniated disc pressing on the nerve.
Throughout the body, including in the discs and nerves within the epidural space, resident regenerative cells are located near blood vessels. These cells may help regulate inflammation and support tissue maintenance. Research indicates that high-dose steroids in epidural injections can damage or eliminate these cells in laboratory settings.
As a result, repeated injections may follow this pattern:
- First epidural injection: This may provide strong anti-inflammatory relief, reduce pain symptoms, and decrease local regenerative cells.
- Second epidural injection: This further reduces inflammation, though fewer regenerative cells remain to support tissue repair and maintenance.
- Third epidural injection: With fewer viable regenerative cells, the anti-inflammatory effect and pain relief may diminish.
Common Conditions Steroid Injections Can Treat
Steroid injections may help manage pain and reduce inflammation in various conditions. Physicians often recommend them for the following:
- Bulging Disc: A bulging disc occurs when a spinal disc extends beyond its normal space without rupturing. Depending on the affected area, it may cause localized pain or nerve compression, leading to numbness, tingling, or weakness in the back, neck, or limbs. Read More About Bulging Discs.
- Carpal Tunnel Syndrome: Carpal tunnel syndrome is caused by compression of the median nerve in the wrist, leading to numbness, tingling, weakness, or pain in the hand and fingers. Symptoms may worsen over time, affecting grip strength and fine motor skills. Read More About Carpal Tunnel Syndrome.
- Radial Nerve Injury: A radial nerve injury can result from compression, trauma, or overuse, leading to weakness, numbness, or difficulty extending the wrist and fingers. Symptoms vary based on the severity and location of the injury. Read More About Radial Nerve Injury.
6 Side Effects Of Steroid Shots That You Should Be Aware Of
Steroid injections may temporarily manage pain and inflammation, but they also carry risks. Repeated use may cause side effects to overall health. Understanding these potential downsides can help inform treatment decisions. Below are six common side effects of steroid injections.
1. Destroying Cartilage
Cartilage, a flexible tissue at the ends of long bones, cushions joints and absorbs shock. When arthritis develops, cartilage wears down, leading to bone-on-bone contact. Cartilage health plays an important role in joint function, and any potential impact on this tissue should be considered when evaluating options for arthritis pain management.
Some research has shown that steroid injections may contribute to cartilage damage. The first study on steroid injection side effects appeared in 1951, with additional studies in the 1960s and animal studies confirming their impact on cartilage cells.
A recent randomized controlled trial on knee arthritis found that patients receiving steroid injections did not experience greater improvement than those receiving saline injections. Additionally, they showed an accelerated rate of cartilage loss.
2: Increasing Risk Of Infection Or Joint Replacement
A single steroid injection may increase the risk of joint infection or the likelihood of needing joint replacement surgery. Research supports these concerns. Studies show that individuals who receive steroid injections for joint pain or arthritis face a higher risk of infection if they later undergo joint replacement surgery. This risk applies to both knee and hip joints.
Research also indicates that steroid injections for knee arthritis pain may raise the likelihood of needing a knee replacement, as they can contribute to further cartilage breakdown. Potential side effects include an increased risk of infection in joint replacements and a greater chance of requiring surgery.
An infected knee or hip replacement can have serious consequences. Treatment often requires surgical washout and 6–12 weeks of IV antibiotics delivered through a catheter near the heart. In some cases, antibiotics alone are insufficient, and the infected joint must be removed and replaced with a new implant.
3: Systemic Problems
Although steroid injections target a specific joint or tendon, they can also affect the body as a whole. High-dose steroids may spread beyond the injection site, potentially impacting bone health, the endocrine system, and blood sugar regulation.
Studies show that steroids used in epidural injections for back pain may worsen osteoporosis in women. These injections can also disrupt the endocrine system by altering cortisol levels, which are key to overall health. Additionally, studies indicate that steroid injections in joints, such as the knee, may raise blood sugar levels.
4. Reduced Recovery Of The Shoulder Rotator Cuff
Research shows that steroid injections may interfere with the healing process of rotator cuff injuries. One study found that patients who received these injections had fewer new blood vessels forming in rotator cuff tears—an essential process for recovery.
A more recent large review reported that patients who had rotator cuff repair after prior steroid injections experienced higher retear rates and were more likely to need additional surgery.
5. Damage To Tendon Cells
Research shows that steroid injections may impact tendon cells, potentially weakening tendon structure over time. Studies have found that patients receiving these injections can experience cellular injury within the tendons, which may reduce strength and resilience, increasing the risk of tendon-related issues.
6. Higher Risk Of Knee Replacement
Recent research suggests that corticosteroid injections may contribute to a higher likelihood of knee replacement in individuals with or at risk of symptomatic knee osteoarthritis.
In a nine-year observational study involving 3,822 individuals, 31.3% of those who received corticosteroid injections eventually underwent knee replacement surgery, compared to just 5.0% of individuals who did not receive these injections. Each additional injection was linked to an estimated 9.4% absolute increase in the likelihood of requiring surgical joint replacement.
For example, receiving four corticosteroid injections over time may increase this likelihood by approximately 36%. These findings suggest that while corticosteroids may provide short-term symptom relief, their repeated use may also contribute to joint deterioration over time.
Why High-Dose Steroid Injections Remain A Treatment Option
Despite growing evidence of their limited long-term benefits and potential risks, high-dose steroid injections remain widely used. Several factors contribute to their continued use.
Many physicians rely on steroid injections due to a lack of accessible alternatives for chronic pain management, especially when interventional orthobiologic solutions are not yet standard in clinical practice. Steroids provide quick relief, making them a frequent choice in the absence of better-known options.
Insurance coverage also plays a significant role. Since steroid injections are typically covered, they remain convenient for physicians and patients. However, this insurance-driven approach may lead to repeated treatments that offer short-term relief but do not necessarily support long-term joint health.
Is There An Alternative Solution to Steroids For Lasting Health?
Platelet-rich plasma (PRP) is a well-researched alternative to steroid injections that may help manage joint function and pain without the risks associated with steroids. PRP treatment involves drawing a small blood sample, concentrating the platelets, and reinjecting the preparation into the affected area to support joint function.
Some research suggests that PRP treatments may support joint function and help manage symptoms of knee osteoarthritis.. Nearly 30 high-level studies suggest that PRP treatments may offer benefits comparable to or greater than those of hyaluronic acid (HA) and steroid injections in some cases.
Discover The Regenexx Approach To Joint Pain
Procedures using Regenexx injectates offer a non-surgical option for managing joint pain and supporting function, particularly for individuals seeking to reduce reliance on repeated steroid injections. One option includes a fourth-generation platelet lysate (PL) injectate, which contains a concentrated blend of natural growth factors derived from the individual’s own blood.
In appropriate cases, physicians in the licensed Regenexx network may use this approach as an alternative to steroid-based injections for addressing spine- or joint-related pain.
If you’re exploring alternatives to steroid injections, consider consulting with a physician in the licensed Regenexx network to learn about interventional orthobiologic options. Procedures using Regenexx injectates aim to support joint health and mobility while reducing reliance on high-dose steroids.
Understanding all available options is key to making informed decisions about pain management and long-term joint care. Schedule a consultation to discuss treatment approaches that may align with your specific needs and goals.
To talk one-on-one with one of our team members about how Regenexx may be able to help your orthopedic pain or injury, please complete the form below and we will be in touch with you within the next business day.
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