Epidural Steroid Injection
The American Chiropractic Association, the leading professional association for chiropractors, states that more than 31 million Americans experience lower back pain at some point in their lives.
A spinal steroid injection is one of the most common medical treatments for lower back pain, and more than 9 million injections are administered to patients every year. The treatment continues to be controversial due to a lack of studies with placebo controls and questions about the potential risks associated with steroids.
Many patients go to their primary care doctor to treat lower back pain. Their doctor may prescribe anti-inflammatories, MRIs, and physical therapy. If the MRI shows a pinched spinal nerve, the next step may be a spinal steroid injection to relieve pain and surgery if the injection does not work.
There is an alternative way to relieve pain and avoid surgery by correcting the root of the problem and addressing it more effectively. Dr. Brian Short compares steroid injections to chiropractic care to determine the better option.
How Do Steroid Injections Work?
Steroids (cortisone) reduces the inflammatory response, which inhibits pain sensation. It does this is by lowering the immune system’s response to inflammation due to nerve or tissue damage.
What is cortisone?
Cortisone is a synthetic version of cortisol, a steroid produced in the adrenal gland and released into the bloodstream in response to stress. Cortisone works like cortisol but is available in a full range of strengths. However, although cortisone and cortisol are steroids, they shouldn’t be confused with anabolic steroids like testosterone. Anabolic steroids enhance male characteristics and improve athletic performance. By contrast, cortisone and cortisol are anti-inflammatories that suppress the immune system and decrease inflammation in irritated tissues.
How do cortisone shots work?
As an orthopedic treatment, cortisone is injected directly into a site of inflammation. Because cortisone is used to treat pain, it is sometimes confused with pain-relieving medications. However, cortisone itself is not a pain medication. Instead, cortisone is an anti-inflammatory that works by preventing collagen production. The injection shuts down collagen-producing cells in the tendon or joint; this action suppresses inflammation and calms nerves, indirectly reducing pain. Also, it’s important to note that cortisone doesn’t actually heal the underlying problem triggering the inflammation.
The amount of time it takes for patients to feel relief after a cortisone injection varies with each patient. Some people report immediate relief, while others report gradual pain reduction over a period of days or weeks. Pain relief may be less robust if inflammation is severe or ongoing and chronic at the time of treatment.
Potential side effects of cortisone shots increase with larger doses and repeated use. Side effects can include:
- Cartilage damage
- Death of nearby bone
- Joint infection
- Nerve damage
- Temporary facial flushing
- Temporary flare of pain and inflammation in the joint
- Temporary increase in blood sugar
- Tendon weakening or rupture
- Thinning of nearby bone (osteoporosis)
- Thinning of skin and soft tissue around the injection site
- Whitening or lightening of the skin around the injection site
Limits on the number of cortisone shots
There’s concern that repeated cortisone shots might damage the cartilage within a joint. So doctors typically limit the number of cortisone shots into a joint. You shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year.
How Do Steroid Injections Compare to Chiropractic Spinal Adjustments?
Although steroid injections can provide pain relief, it is essential to remember that this pain reduction is temporary and only addresses the symptoms rather than the actual cause of the pain, which is typically a pinched or compressed spinal nerve. While it's true that stopping or reducing the pain is a welcome relief, being able to address the root cause for long-term correction is the goal of chiropractic care.
The basis of all chiropractic philosophy rests with the spine. If the spinal vertebrae or discs shift out of alignment, they can place pressure on the nerves leading in and out of the spine to various body regions. These misalignments (subluxations) alter the normal biomechanics of the joint leading to conditions such as sciatica or herniated discs. Once the spine is back in proper alignment, the pressure on the spinal nerve is relieved allowing the nerve to heal. Once the nerve heals, pain, inflammation and associated muscle contraction will be resolved.
The main advantage of chiropractic care over steroid injections is longer-lasting pain relief. Correcting the actual cause of the problem by restoring normal articular function and spinal biomechanics will prevent the symptoms from recurring without the expenses that are frequently associated with epidural injection treatment, including consultations with clinicians, multiple injections, and possible surgery. Most patients seeking epidural steroid injection treatment should expect the fee to be around $4,000.00 at a minimum. The sessions themselves can become more costly depending on how many injection sites are on the body. Each epidural steroid injection is billed as a separate cost.