Steroid Injections for Back Pain
Steroid shots can reduce inflammation, providing relief for back pain from some, but not all, causes.
If you're suffering with low back pain, the idea of getting an injection to take the pain away seems like the ultimate solution. But it's not that simple.
For some people, an injection of a corticosteroid (commonly called a steroid), which is a powerful anti-inflammatory medication, can help relieve pain and other symptoms. But it's not right for everyone. Even when a steroid shot is appropriate, it is just one part of a comprehensive treatment plan. In addition, your physician must determine the right type of injection to give.
Getting To The Cause
To better understand the cause of your back pain, your physician will start by asking questions and performing a physical examination.
Most back pain comes from stress and strain on muscles. "People can overwork their bodies and develop muscle spasms, which can feel severe," says Ellen W.K. Rosenquist, MD, a physician in the Cleveland Clinic Center for Spine Health. Steroid injections are not used for muscle pain. Rest, heat, ice and over-the-counter pain medications followed by physical therapy is the recommended treatment.
"If the physical examination shows that pain is related to arthritis or a problem with the sacroiliac joint, I would consider a steroid injection," says Dr. Rosenquist. With these conditions, muscle pain can be secondary to the underlying arthritis, as the muscles try to splint the area.
Degenerative processes in the spine can lead to several problems that might benefit from reducing inflammation with a steroid shot. To better understand them, here's a quick anatomy lesson:
The spine consists of a column of bones (vertebrae), each of which has a cylindrical body with bony projections at the back. The cylindrical bodies are separated by shock absorbing cushions (disks). The bony projections connect each vertebra to the one above and below at small joints called facet joints. Just below the column of vertebrae, there's a triangular bone called the sacrum, which connects to the pelvic bones. This three- to four-inch long connection is called the sacroiliac joint.
A hollow column that runs through the middle of the spine contains the spinal cord. Nerves extend from the spinal cord through openings between vertebrae. Nerves that originate in the lower spine go down the legs.
As we age, several problems can occur in the spine, which may or may not cause symptoms. Disks can degenerate, narrowing the space between vertebrae. Sometimes the soft center of the disk can push through the tough outer layer, causing a herniated disk. Certain degenerative changes in the spine can lead to a narrowing of the spinal canal or of the spaces where nerves leave the spinal canal, a condition called spinal stenosis.
The facet joints are vulnerable to the same arthritic process as other joints. With osteoarthritis, the cartilage, which covers the ends of bones in joints, wears down. Uneven surfaces and bone rubbing against bone can cause inflammation and pain.
The sacroiliac joint can become dysfunctional simply from the stresses and strains of helping us to stand and walk. It can also develop arthritis.
Conservative Measures First
Regardless of the cause of back pain, Dr. Rosenquist starts with conservative measures, including physical therapy. Injections are not a substitute for other treatment. "I'm not going to do an injection and nothing else and say that's going to cure you," she says.
But if you've tried everything else and pain and other symptoms persist, a steroid injection may help to relieve pain enough to significantly improve your function. There are three types of steroid injections for the spine, depending on the underlying cause of symptoms.
Pain along with numbness or tingling that travels down the leg suggests that a nerve in the lower spine is being pinched or compressed. The most likely causes are a herniated disk or spinal stenosis. When a nerve is compressed it becomes inflamed.
In this case, the corticosteroid injection is directed to the level of the spine where the nerve is affected. It is injected into the epidural space, which is the area above the thick membrane that surrounds the spinal cord (called the dura).
"The medication will diffuse through the dura into the area where the spinal cord and nerves lie," Dr. Rosenquist explains. "It doesn't open the narrowed space, but it reduces swelling that contributes to the compression."
Facet and SI Joint Injections
Low back pain that occurs by itself or along with radiating pain down to the buttocks or upper leg, but not lower than the knee, may stem from osteoarthritis in a facet joint. If the pain is down very low on the back, the sacroiliac joint may be at fault.
The arthritic process in joints produces inflammation, which can lead to pain. The goal of a steroid injection directed at a facet or SI joint is to reduce the inflammation.
How It's Done
Once the right type of steroid shot has been determined, the injection is done with the help of an X-ray machine so the doctor can pinpoint the exact location where the medicine should be placed.
The steroid is given along with a numbing medicine. While the steroid can take up to 10 days to work, the numbing medicine will work right away. But the effect won't last long. "I tell my patients not to worry if they feel good right away and then they don't a few hours later when the numbing medication wears off," says Dr. Rosenquist.
Once the effect of the steroid does kick in, the pain relief can make it easier to do physical therapy and exercises. Dr. Rosenquist emphasizes the importance of continuing with all aspects of treatment. "If I do an injection and you don't do all of the other things, it is going to get worse again," she says.
In the short term, there may be some pain at the site of the injection on the first day, and you may have some facial flushing. People with diabetes will have their blood sugar levels monitored because steroids can raise them. There's a small risk of infection. But this is minimized by doing the procedure under sterile conditions.
Steroids, like other medicines, don't work for everyone. The reasons are not entirely understood. If you do have a good result, the injection can be repeated three or four times a year if needed.
Steroid Injections For The Spine
Epidural. Reduces inflammation from a pinched or compressed nerve from spinal stenosis, a herniated disk or bone spurs.
Facet Joint. Reduces inflammation from osteoarthritis in the small joints at the back of the vertebrae (facet joints).
Sacroiliac Joint. Reduces inflammation from osteoarthritis in the joint between the triangular bone at the base of the spine (sacrum) and the pelvic bones.