Corticosteroid injections have been used for decades to temporarily relieve pain and inflammation in joints and soft tissues, and to relieve systemic inflammatory reactions. The advantage to injecting corticosteroid medication rather than taking it orally is that it is delivered more quickly to the affected area and often has more effective results. Corticosteroid injections are routinely used to reduce the pain and swelling of bursitis, tendonitis and arthritis. In addition, they are helpful in treating lupus, scleroderma and severe allergic reactions. Corticosteroid injections are also very effective in reducing spinal or radiating limb pain (radicular pain) when injected into the epidural space, which is between the dura, the outer layer covering the brain and spinal column, and the spine itself. When used this way, they are referred to as epidurals, which are frequently used for labor pains during childbirth.
Corticosteroid injections are often given as part of rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection typically lasts from 1 week up to 1 year. A typical positive response may last for 1 month. If successful, these injections can be repeated at 2-week intervals, but usually no more than three or four times. Corticosteroid injections can also be of diagnostic value in pinpointing the regional source of the pain, determining its severity, and assisting the physician in developing an appropriate treatment plan.
The Corticosteroid Injection Procedure
Corticosteroid injections are usually administered by the prescribing doctor in an outpatient facility under the guidance of fluoroscopy or ultrasound to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is usually not painful, although the patient may feel pressure at the injection site. The injection procedure takes only a few minutes. Although the steroids themselves are not analgesics, they alleviate pain as a result of reducing inflammation.
In most cases, the patient experiences immediate pain relief from the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid reduces inflammation, the patient should feel a significant, if not total, reduction in pain. The patient can usually resume normal activities the day following the procedure.
Risks of Corticosteroid Injections
For most patients, corticosteroid injections are safe. As with all medical procedures, however, there is a possibility of complications. In rare instances, patients who have received corticosteroid injections have experienced headaches, bleeding, infections, nausea, vomiting, allergic reactions and nerve damage. This treatment should not be administered to patients who are pregnant or have a bleeding disorder or an infection. Because corticosteroids can temporarily elevate blood pressure and blood sugar, and affect mood, patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment. Because there is the capability for tendon or ligament rupture, injection directly into them should be avoided. Repeated injections near these structures can also weaken these supportive soft tissues. Joint injections have also demonstrated the potential for destruction of the articular cartilagenous surface and thinning of the bone cortex.