Danger of Steroid Injections

Steroid injections are frequently used for “Interventional Pain Management”, despite their dangers and increasing warnings from the FDA.

Still, these procedures are a mainstay of the non-opioid treatments recommended by the CDC. While they can work miracles for some people, their effects are additive over time and eventually become destructive.

Additionally, due to the exactness whereby this procedure is performed, there is no margin for human error. The needle must be placed in the tiny space (~one millimeter) between the ligamentum flavum (ligament between vertebrae) and the actual spinal cord (nerve trunk).

The picture below shows why there is such a high probability of mistakes in needle placement:

In this context, “steroids” refer to corticosteroids, like prednisone, NOT anabolic steroids, like testosterone.

From Wikipedia:

• Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones.
  Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiologic processes, including stress response,immune response, and regulation of inflammation,carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.
• Anabolic steroids, also known more properly as anabolic-androgenic steroids (AAS), are steroidal androgens that are structurally related to and have similar effects as testosterone in the body. They are anabolic and increase protein within cells, especially in skeletal muscles.

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I’ve been warning about epidural steroid injections literally for years:

2018

• Epidural Steroid Injections: Danger Worth the Benefits?
• The Pain Industry’s New & Dangerous Fall-Back
• Epidural Steroids Associated With Decreased Bone Density

2017

• Epidural Steroid Injections Overused

2016

• The Safety of Epidurals: What You Need to Know
• Potential Complications Of Epidural Steroid Injections
• Untrained pain docs performing epidural steroid injections

2015

• Interventional pain procedures increasing faster than opioid prescribing
• Epidurals, Opioids, Pain Treatments
• Serious Neurologic Events after Epidural Glucocorticoid Injection
• Spinal injections: comprehensive review of the literature

2014

• Another Warning: FDA Advisers Tackle Epidural Steroid Shots  
• My Story: Disabled by an Epidural
• FDA warns about Steroid Injections
• Epidurals Linked to Paralysis
• How Safe Is Epidural Steroid Injection?

2013

• Hidden Danger of Intraspinal Steroid Injections
• Spine Injections May Set Stage for Fractures
• Injections for back pain: The evidence is weak

 

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The article below is from a fellow researcher and longtime Inspire.com-EDNF forum member, “SlapASmileOn”.

Steroids break down collagen cells. Steroid injections hasten the damage to your connective tissue, something that those with EDS really do not help with. Oral steroids do this, though injections with steroids damage the tissue that much more quickly. The damage may not be seen or felt immediately, but the cumulative effect can cause you to have much greater instability, pain, and damage. Thus steroid treatments should not be thought of as a long-term solution.

As an example, you can see where steroid injections are used to purposely break down collagen in scar revisions: http://www.kpcosmeticservices.com/services/scar-revision.cfm

This link talks about collagen necrosis (death of the tissue) increases with steroid injections for plantar fasciitis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684947/

And this link is about tricep tendons rupturing following steroid injections following rotator cuff injuries: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071041/

Finally, this study showed bone loss and an increased risk of bone fractures in post-menopausal women who received steroid injections in the hip: http://journals.lww.com/spinejournal/Abstract/2012/12010/Effect_of_Epidural _Steroid_Injection_on_Bone.13.aspx

These linked articles demonstrate the damage to tissue of those with “normal” tissue. So extrapolate what happens in our bodies where the defect in collagen that makes up that tissue is injected with steroids or when they are taken orally for distribution throughout the body. The damage occurs that much more easily and/or that much more significantly.

While specific studies of prednisone and EDS have not been done, there have been studies which suggest this should not be used if other options exist.

For instance, in this study, Prednisone was shown to inhibit Connective Tissue Growth Factor (CTGF) (yes, we need that to build our connective tissue) in mice: http://www.ncbi.nlm.nih.gov/pubmed/21699635

And another one where long-term usage in a 13-year-old boy was shown to degrade his costal cartilage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2032211/

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However… oral hormonal steroids, like androgens, can be also be used as a treatment modality for chronic pain. See:

• Lower sex hormones associated with musculoskeletal pain – 2016
• Opioid-Induced Androgen Deficiency – 2015
• Hormone Therapies: Newest Advance in Pain Care – 2014
• Testosterone Replacement in Chronic Pain Patients – 2014