Many of us take Tylenol, Ibuprofen or Aleve every other day to reduce our headache, back or knee pain. These medications belong to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs) which function to reduce inflammation and pain but present with some unwanted side effects like upset stomach, acidity and can adversely affect kidney function.
Gluco-corticosteroids commonly known as cortisone or steroids are natural molecules released from our Adrenal glands which are located just above our kidneys. In urgent situations, our body goes into flight and fight mode, where it runs on a high state of these natural chemicals leading us to feel a boost of energy, experience minimal pain, or feel any other bodily needs.
Three to five injections of a standard dose of steroid injections (Dexamethasone 10mg, Methyl Prednisone 40 mg) per year are considered safe. Patients may observe some transient side effects of these steroid medications such as raised blood sugars, which reverse back to normal levels within a few weeks.
Higher dosage and frequent steroid injection do cause cartilage damage in your joints. However, the use of the lowest possible dose along with infrequent use is safe, especially if one injection relieves pain and improves function for many months.
Frequent, prolonged use of steroids depletes the body’s energy reserves and affects the gastric mucosa. It has also been shown to suppress the immune system and negatively affects bone density. Therefore, one needs to be watchful of any prolonged use of steroid medications.
Infrequent use of Steroid Medication has been shown to be very effective in managing pain in several conditions such as:
- Degenerative Joint diseases (Shoulder, Hip, Knee, Ankle)
- Acute disc herniations in the spine (Neck or Lower back)
- Spinal or Facet Arthritis
- Spinal Stenosis and
- Spinal Scoliosis that causes foramina stenosis or nerve impingement
On the other spectrum are Regenerative Therapies like Platelet Rich Plasma (PRP) and Stem Cell Therapy that have come to the forefront in the last couple of decades and have been primarily used to promote natural healing in sports related injuries for many famous athletes.
These new therapies have provided an alternative route for healing to many patients who want to avoid surgery or want more out of their treatment than just suppressing pain. They have brought to attention the super healing powers of our bodies as both the platelet concentrates, and the mesenchymal stem cells are derived from our blood and bone marrow. The use of both PRP and Stem cells derived from the blood or bone marrow of the patient undergoing the procedure is well studied and deemed safe in the medical community. The PRP and Stem Cells are injected close to specifically damaged tissue using Ultrasounds and/or Fluoroscopy guidance and have been shown to be particularly helpful in the treatment of mild to moderate Degenerative Arthritis, Degenerative Disc Disease, Tendinitis, Ligament Injury, Sacroiliac Joint pain as well as Facet related back pain.
Using Platelet Rich Plasma (PRP) we can boost our body’s natural healing powers to slow down and even reverse the degenerative process and recover faster from injuries.
Use of Mesenchymal Stem Cell Therapy, has the potential to help regrow cartilage, menisci, and collagen in patients suffering from degenerative disc disease thus reversing years of wear and tear process in the body.
Even though there is substantial evidence now demonstrating the effectiveness of these therapies they are yet to be approved for medical use by the FDA and therefore most medical insurances currently do not provide coverage for them. Due to this reason, in-spite of their many benefits, these therapies are costly and not easily accessible to everybody.
CONCLUSION: Regenerative therapies like PRP or Mesenchymal Stem cell therapy has come to forefront to treat degenerative conditions and acute sports related injuries. Steroids although comes with many side effects, it still has a major role to play in acute painful conditions.
Sanapati et al 2018; Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Meta-analysis. Pain Physician 2018: 21:515-540
Kennedy et al 2018; A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation. The Spine Journal 18 (2018) 29–35
Bowles and Setton 2017; Biomaterials for intervertebral disc regeneration and repair. Biomaterials 129 (2017) 54 – 67
Koltsov et al 2018; Lumbar epidural steroid injections for herniation and stenosis: incidence and risk factors of subsequent surgery. The Spine Journal (2018)1-7
Sivaganesan et al 2016; Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology. The Spine Journal 16 (2016) 928–934Leave a reply