A cortisone injection for back pain is a commonly utilized form of steroid treatment for a variety of painful dorsalgia complaints. Steroids in general, and cortisone, in particular, are used primarily to battle inflammation. The inflammatory process has long been implicated in being involved in causing many back pain concerns, yet is virtually never actually observed or documented in the overwhelming majority of patients. When inflammation is observed, it is usually a result of the painful condition; not a cause of it. It is for this and other reasons that we recommend that patients think twice before undergoing a back pain steroid injection procedure using cortisone, since the key ingredient is unlikely to have any lasting positive effect and does produce some substantial degree of risk.
This commentary provides an objective look at the cortisone injections that are used to symptomatically treat back pain in virtually all forms.
Steroids are recommended as a treatment for many injuries when inflammation is obviously present. However, in the back pain treatment sector, they are used most often for diagnoses involving spinal sources, far more often than soft tissue pathologies. Herniated discs, facet joint syndrome, spinal arthritis and a variety of other spinal abnormalities do not typically involve any significant widespread inflammatory processes which can be effectively treated by a single injection site. However, this does not prevent cortisone injections from being used millions of times each year to treat pain from these diagnosed causations. What is the logic in this?
If no inflammation is present, then cortisone would seem to have no indicated use. Add to this fact the hazards of injected cortisone and patients would be wise to think carefully before acquiescing to this choice of therapy.
Cortisone, and all steroids, can be harmful. The ingredients can break down joints and cause a variety of complications, especially upon the repeated exposure perpetrated so often against back pain patients. There is much speculation about what constitutes “too much” treatment using injected cortisone. This is because some patients have truly horrible and lasting side effects from a single treatment. Although many of these patients did not have a truly problematic structural issue to begin with, after repeated rounds of cortisone, there may be something to really worry about.
Cortisone has been theorized to cause permanent damage to spinal structures, especially when used frequently and regularly. Bone loss, tissue death, cartilage disintegration, tendon destruction and nerve damage are all possible complications, with some of these being considered probable effects of repeated injection therapy to the same location.
It seems ironic that many patients do indeed undergo a lengthy series of injections as purely symptomatic care, usually as a pre-cursor and qualifier for surgical treatment. The irony, of course, comes from the fact that the cortisone is probably doing far more harm than good in the vast majority of patients, since most do not cite positive curative results, or even large degrees of symptomatic reduction, even from repeated rounds of treatment.
Before undergoing even a single cortisone spinal injection, we sincerely hope that any patient will at least learn the facts for themselves and discuss the significant risk factors with their doctor.
I am not completely against all forms of injection therapy. I do believe that the few rare cases of extreme neurological sensitivity attributed to chemical radiculitis can be effectively treated using injections of Lidocaine and flushing solution. I also believe that the partial and temporary relief experienced in the vast majority of epidural injections also has nothing to do with the steroid content at all, but instead are direct results of that same Lidocaine anesthetic or the placebo effect. Too bad this ingredient wears off so fast, allowing the pain to return in all its misery.
If you do decide on pursuing injection treatment for back pain, do yourself a favor: Learn the risks and do not expect more than a temporary pain reliever in the form of a syringe. It is too bad that doctors do not share this common knowledge with every patient, since most are so hopeful of finding a cure at the end of that needle and are greatly disappointed when the partial relief produced fades so fast. There is truly nothing worse than when the pain comes back worse than ever before.
Actually, there is one possible worse scenario: When cortisone injections are given haphazardly, just to “exhaust all conservative options” and qualify the patient to undergo invasive and unnecessary spinal surgery. Now, the patient has damaged spinal joints, from the multiple rounds of cortisone, and possibly far worse damage inflicted by the surgical barbarism. Is this medicine or torture?