Are steroid shots for you?

Say the word 'steroids' and many people automatically think of sport cheaters and oversized hulking athletes. That is not what we're going to talk about (and not the same thing at all).

Steroid (short for corticosteroid) injections are used to treat pain from inflammation, not to hit 60 home runs in a season.

These steroids are medicines used for treating pain by reducing inflammation in an area such as a joint or muscle thus improving function and mobility. They are used to treat a number of conditions including arthritis, bursitis, tendonitis, lower back pain and trigger points (hard, knot-like area in a muscle that results from repetitive stress on the muscle and most often found in the neck, back, shoulders and hips).

Steroids may be administered by injection, orally or by intravenous drip. While all can be effective, for site-specific pain most commonly treated with steroids, an injection is the only way to go, as it gets the most medicine into the location where it is needed and provides maximum effect.

As with any treatment choice, there are both benefits and risks from steroid injections. While they are considered an excellent choice for short-term treatment for certain conditions, studies are not particularly definite about the benefits. Steroids have been shown to work for up to three months in reducing hip arthritis pain; different studies showed the same benefit for knee arthritis, but only for two to three weeks. In another study, steroid injections used for carpal tunnel syndrome led to improvement in symptoms at 10 weeks (in comparison to a placebo); there was no difference at one year.

And there are certain risks to steroid treatments, but these are uncommon and generally mild and temporary. The main side effect of the injection is minor pain and swelling at the injection site and occasionally, skin discolouration. There may be an allergic reaction or even local bleeding, but both are extremely rare.

In some cases these injections may weaken tendons or connective tissue or lead to rupture, again on rare occasions. Some people will experience a post-injection 'flare' where symptoms temporarily get much worse. The most common side effect is temporary impairment in blood sugar regulation, something anyone with diabetes should be very careful about. Ongoing treatment may also lead to bone loss so should be carefully monitored.

Before opting for a steroid injection, discuss the advantages and possible risks with your doctor who can take your full medical history and health into account. A steroid injection may not be the best first line of therapy. Indeed, steroids are overused for back pain as it is. But in some cases such as bursitis and rotator cuff inflammation, an injection may be all you need.

Steroid injections can be an effective way to decrease pain and improve function but in most instances, the relief they offer lasts only a short time. Nor do steroids cure the illness. In any case, whatever the treatment, steroid shots should not be used more than two or three times per year.

Editor's note: Dr. Paul Martiquet is the medical health officer for rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.

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