Health Matters
Many benefits, complications of steriod medications
Aging is a predictable component of life. Time marches on and entropy will have its way. Many people develop musculoskeletal pain as they grow into their later years but want to stay active. Resolving these predictable problems is an important goal, and has the potential to benefit millions of Americans. A frequent method employed by physicians for joint pain is an injection. But what are they putting in there?
Corticosteroid shots (aka cortisone) are an extremely common method of treating a painful joint or tendon. This drug is injected because of its ability to relieve pain and inflammation in a specific area, to a specific structure. Some common targets for a steroid injection are the ankle, elbow, hip, knee, or spine. Even small joints of the hands and feet can benefit.
Corticosteroids are used for many different problems and administered in various ways. These drugs are effective because of their similarity to hormones produced by your adrenal glands, made to fight stress. These substances reduce inflammation, which is why they are prescribed for numerous and varied conditions. Many maladies involve heightened levels of inflammation, making steroids an obvious choice.
Steroids taken orally can have different consequences than those injected for a symptomatic anatomic structure, primarily due to the amount of drug in your circulation. Although generally safe when used short term, perhaps a week or two, the side effects of long term administration can be significant. From swelling of the legs to increased blood pressure, thinning of bone, a rise in blood sugar levels, even mood swings and psychiatric disturbances, all can result from prolonged use.
Steroids of a different kind have made the headlines over the years. Anabolic steroids are occasionally prescribed medically but are more commonly taken illicitly by those looking to add muscle mass. Because of their effect on metabolism, this type of corticosteroid can lead to kidney damage, liver failure, cancer, and an enlarged heart.
These complications of anabolic steroids are not seen with catabolic steroids, the kind injected into a joint for pain relief. Cortisone, an outdated term referring to a specific type of corticosteroid, is used to treat numerous musculoskeletal conditions. When a structure is painful due to inflammation, injection of a steroid is probably an option. Depending on the situation, this may be performed in conjunction with other therapies or treatments.
A common question is how long will a corticosteroid injection help for? The answer varies according to the cause. If the root of the inflammation is on-going and active, the cortisone will provide only temporary relief. But for quick reduction of pain, steroids can be effective, as long as the physician understands it is probably just a band-aid, buying the sufferer some time. The more important query is why the affected body part became inflamed in the first place, and how to prevent its recurrence in future.
By way of an example, let’s look at cortisone injections for heel pain, a common condition typically caused by plantar fasciitis (a painful arch ligament). Too often, an injection is given by a health care provider when a patient presents with this complaint……but nothing else is done. Since the condition usually develops over time because of the arch moving too far out of position, the injection’s benefits are transient. But add it to concurrent use of some kind of supportive device for the arch, be it a specialized strapping or a custom arch support, and the odds of lasting relief are much higher.
Corticosteroid shots can be effective in treating inflammatory arthritis, such as rheumatoid arthritis. They can also be part of the plan for other conditions, including back pain, hip bursitis, a gout attack, or tendinitis. Issues occur when it is the only therapy utilized, administered repeatedly over the months or years. Overuse of injectable steroids is common and leads to some predictable complications.
Although the amount of drug getting into the bloodstream is small via a shot, you can still have systemic, whole-body complications from an injection. But they are far less likely. Regardless, if you have enough corticosteroid drug in you, it can reduce the effectiveness of your immune system. Suppression of your adrenal gland frequently develops, leading to weight gain and water retention. Cardiac disturbances can also ensue.
For good reason, no one wants to live with chronic pain – and yet many do. Technology has brought forth all manner of machine to reduce this kind of discomfort, many of which are non-invasive and have no side effects. No doubt, steroids have a vital place in the treatment of numerous conditions, all owing to their ability to alter inflammation. Corticosteroids have a long and successful track record of use in medicine. But like everything in nature, too much of anything is a bad thing. Be careful of long term steroid use; there are complications, and probably other options.
Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.