With the memory of last year’s meningitis outbreak attributed to contaminated steroids for sale injections still fresh in many back pain patients’ memories, a new study out of Johns Hopkins suggests that steroids may not be a necessary ingredient in pain-relieving injections.
For years, steroids have been believed to relieve spinal pain because they act as powerful anti-inflammatories. Studies conducted into their effectiveness in relieving spinal pain have yielded mixed results, sometimes in the form of equal treatment effectiveness with placebo injections. What the new study shows is that the real active ingredient in injections may be the fluid itself, explaining why the “placebo” injections may have had the same results as those containing steroids.
Researchers analyzed 3,641 patients’ medical records to compare the effectiveness of different types of injections. Their focus was comparing the effects of injections into muscles around the spine with those of injections administered in the epidural space, which surrounds the spinal cord. They concluded that epidural injections were more effective than intramuscular ones, but realized another finding: Injections without steroids, containing anesthetic or a simple saline solution, consistently performed as well as those containing steroids.
These results suggest that steroids may be an unnecessary ingredient in spinal injections. While the type of contamination described above is rare, there are other reasons to be concerned about steroid injections; they’ve been associated with increasing blood sugar levels and increasing the risk of osteoporosis in women. Another concern the researchers note is that steroids are only safe to use a limited number of times each year; if they’re eliminated from the injections, patients in severe pain may be able to receive more frequent injections to relieve pain consistently without the side effects and risks associated with steroid use.
For now, researchers are being cautious with their recommendations. The study’s lead author, Mark Bicket, MD, suggests that doctors reduce the amount of steroids in spinal injections for now while awaiting further research before dropping them completely.
It’s important to remember that there are risks with any type of epidural injection, such as infection, abnormal bleeding and nerve damage. Though rare, these risks need to be taken into consideration. Injections are an invasive form of treatment, and invasiveness comes with risks. Whenever possible, consider natural alternatives such as movement therapy, massage, acupuncture and mind-body therapies for pain management.
