Steroid injections are a common treatment for managing pain, especially in conditions like arthritis, tendonitis, and back pain. It’s important to note that these steroids are corticosteroids, which are different from anabolic steroids used by bodybuilders to increase muscle mass and strength. While they can provide rapid relief, it’s crucial to understand their potential side effects, long-term risks, and alternative options. This article, written by leading pain specialist Mr Oliver Eaton, explores the latest research, real patient experiences, and expert recommendations to help you make informed decisions about your pain management.
What Are Steroid Injections for Pain?
Steroid injections, also known as corticosteroid injections, are used to reduce inflammation and relieve pain in joints, muscles, and soft tissues. Steroid medicines (also known as corticosteroids) are used for pain relief. They are commonly administered for conditions such as osteoarthritis, sciatica, and bursitis [1]. Bursitis is the inflammation of bursae, which are fluid-filled sacs that cushion joints. The procedure involves injecting a synthetic version of cortisol, a hormone naturally produced by the adrenal glands, directly into the affected area.
Common examples of steroid injections include joint injections and cortisone injections, which are used to treat a variety of conditions. Steroid injections are often used to treat chronic inflammation and pain and inflammation in joints and soft tissues. A local anaesthetic is often used to numb the area before the injection.
How Steroid Injections Work
Steroid injections, often referred to as cortisone shots, are a targeted treatment designed to reduce inflammation and relieve pain in specific areas of the body. These injections deliver a steroid medication—typically a type of corticosteroid—directly into the affected area, such as a joint, soft tissue, or other site of inflammation. By suppressing the immune system’s response, corticosteroids help to reduce inflammation, which in turn eases pain and swelling. This makes steroid injections a valuable option for treating conditions like rheumatoid arthritis, inflammatory arthritis, and other forms of arthritis, as well as soft tissue problems such as tendinitis and bursitis. The goal of this treatment is to provide rapid pain relief and improve mobility by addressing the underlying inflammation causing discomfort.
Preparation for the Procedure
Proper preparation is key to ensuring your steroid injection is both safe and effective. Before your appointment, your healthcare professional will review your medical history and discuss any current medications, including steroid tablets and other medicines you may be taking. It’s important to inform your healthcare professional if you are on blood thinners or have any allergies, as these factors can affect the procedure. You may be advised to temporarily stop certain medications before your steroid injection. On the day of your treatment, wear loose, comfortable clothing that allows easy access to the injection site. Since you might experience some numbness or mild discomfort after the procedure, consider arranging for someone to drive you home. Open communication with your healthcare professional will help ensure the best possible outcome from your steroid injection.
Having a Steroid Shot: What to Expect
Receiving a steroid shot is usually a quick and straightforward process. Your healthcare professional will begin by cleaning the injection site thoroughly with an antiseptic solution to minimize the risk of infection. In many cases, a local anesthetic is used to numb the area, making the procedure more comfortable. The steroid medication is then carefully injected into the affected joint or soft tissue using a fine needle. You may feel a brief pinch or stinging sensation as the needle is inserted, but this discomfort typically lasts only a few seconds. The entire procedure generally takes about 10 to 15 minutes. After the injection, you may be asked to remain at the clinic for a short period so your healthcare professional can monitor you for any immediate reactions before you head home.
Aftercare and Recovery
After your steroid injection, following your healthcare professional’s aftercare instructions is essential for a smooth recovery. It’s common to experience some pain, swelling, or redness at the injection site, but these side effects usually subside within a few days. Applying an ice pack to the area can help reduce swelling and discomfort. Resting the affected joint or area for a couple of days allows the steroid medication to start working effectively. As you recover, you can gradually increase your activity level, but it’s best to avoid strenuous activities or heavy exercise until you feel comfortable. If you notice any severe side effects, such as increased pain, swelling, or difficulty moving the affected joint, contact your healthcare professional promptly. Proper aftercare helps maximize the benefits of your steroid injection and supports your journey to pain relief.
Common Side Effects of Steroid Injections
While many patients experience significant pain relief, steroid injections can cause a side effect. Most are mild and temporary, but some may be more serious:
- Pain and Swelling: Temporary discomfort at the injection site is common and usually resolves within 48 hours [2].
- Skin Changes: Thinning of the skin, lightening of skin color, or dimpling may occur around the injection site. Skin discoloration may appear a few weeks after the injection and is usually temporary.
- Facial Flushing: Some people experience redness and warmth in the face for a few hours after the injection.
- Elevated Blood Sugar: Corticosteroid injections can temporarily increase blood sugar levels, especially in patients with diabetes. Patients with diabetes should monitor their blood sugar levels and consult their doctor.
- Infection: Although rare, there is a small risk of infection at the injection site. These effects rarely occur. Patients with autoimmune diseases, such as lupus or rheumatoid arthritis, may be more susceptible to infections.
- Allergic Reaction: Extremely rare, but possible.
- Weight Gain: Weight gain is a rare side effect, mainly with repeated or high-dose injections.
There is an increased risk of complications in patients with autoimmune diseases, bleeding disorders, or high blood pressure. Patients with a bleeding disorder or high blood pressure should inform their health professional before receiving an injection.
Doctors and health professionals should be consulted about potential side effects and risks to ensure safe and appropriate treatment.
Long-Term Risks of Steroid Injections
Repeated steroid injections can increase the risk of more serious complications, including:
- Joint Damage: Overuse may accelerate cartilage breakdown, potentially worsening joint health [3].
- Tendon Rupture: Steroids can weaken tendons, increasing the risk of rupture.
- Osteoporosis: Frequent injections may contribute to bone thinning over time.
- Suppressed Immune Response: Long-term use can suppress the immune system, reducing your body’s ability to fight infections.
While steroid injections can relieve symptoms, they do not address the underlying cause of the condition.
For these reasons, most guidelines recommend limiting steroid injections to no more than three to four times per year in the same area [4].
Case Study: Steroid Injections for Chronic Knee Pain
Patient: Female, 52, with chronic osteoarthritis of the knee.
Treatment: Received three steroid joint injections over 12 months for chronic joint pain.
Outcome: Initial injections provided significant joint pain relief, but by the third injection, benefits diminished and she developed mild skin thinning at the injection site. After discussing alternatives, she transitioned to prolotherapy, which resulted in sustained improvement and no further side effects.
Treatments: Alternatives to Steroid Injections for Pain
If you are concerned about the risks of steroid injections, several evidence-based alternatives are available to help treat inflammation and pain:
- Physical Therapy: Targeted exercises can improve strength and mobility.
- Platelet-Rich Plasma (PRP): Uses your own blood components to promote healing.
- Prolotherapy: See below for more details.
- Medications: While steroid medicines (corticosteroids) are sometimes used to reduce inflammation and pain, alternatives such as non-steroidal anti-inflammatory drugs (NSAIDs) and other pain relievers may be preferred in some cases.
- Lifestyle Modifications: Weight management, activity modification, and ergonomic adjustments.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with pain.
As prolotherapy is helping to treat the root cause of pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Expert Recommendations
Before considering steroid injections, consult with a qualified pain specialist to discuss your symptoms, medical history, and all available treatment options. It is essential to seek advice from healthcare professionals to ensure that any procedure, including steroid injections, is safe and appropriate for your condition. At ProHealth Clinic, we prioritize patient education and long-term outcomes, offering a range of regenerative therapies tailored to your needs.
Frequently Asked Questions
Are steroid injections safe for pain?
When administered by an experienced clinician, steroid injections are generally safe for short-term pain relief. However, repeated use increases the risk of side effects and long-term complications.
How long do steroid injection side effects last?
Most side effects, such as pain or swelling at the injection site, resolve within a few days. Rare complications may last longer and should be discussed with your doctor.
Can I have multiple steroid injections for pain?
Yes, but most guidelines recommend limiting injections to three or four per year in the same area to reduce the risk of joint damage and other complications.
What are the alternatives to steroid injections for pain?
Alternatives include physical therapy, prolotherapy, PRP, medications, and lifestyle changes. Consult a specialist to determine the best option for your condition.
Is prolotherapy effective for pain?
Research and clinical experience suggest that prolotherapy can be effective for many types of pain, especially when other treatments have failed. It works by stimulating the body’s natural healing processes.
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating pain, with patients travelling to see him from across the UK, Europe, and the Middle East. With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with pain and providing effective treatment options to alleviate them. He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany. Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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References
- National Institute for Health and Care Excellence (NICE). “Corticosteroid injections for pain relief.” NICE.
- Arroll B, Goodyear-Smith F. “Corticosteroid injections for osteoarthritis of the knee: meta-analysis.” BMJ. 2004;328(7444):869. BMJ.
- McAlindon TE, et al. “Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis.” JAMA. 2017;317(19):1967-1975. JAMA.
- American College of Rheumatology. “Guidelines for the Management of Osteoarthritis.” ACR.