Steroids for Chronic Back Pain Relief

Steroids, such as prednisone and other oral steroids are often used to manage chronic back pain when more conservative treatments—like rest, exercise, and over the counter (OTC) treatments—don't work. Corticosteroids can also be injected into the inflamed area to alleviate the pain and swelling.

With chronic back pain, your usual activities and exercises can fuel chronic inflammation by constantly irritating the affected area.

Man with back pain.
Laura Porter / Verywell 

When the back pain runs down one leg, the condition is often referred to as sciatica, and it occurs due to irritation and inflammation of the spinal nerve root. A steroid injection (spinal epidural) for the treatment of back pain is among the most common interventions for back pain caused by irritated spinal nerve roots. 

How Do Corticosteroids Work?

Inflammation is produced by the immune system to help fight infections and heal damage, but it can be harmful in some situations. Corticosteroids block the damaging effects of inflammation through several mechanisms.

Corticosteroids inhibit the production of prostaglandins, as well as other chemicals. Steroids simulate the hormone cortisol, which your body produces naturally in the adrenal glands (small glands that sit on top of each kidney). Cortisol has many actions, including suppression of the immune system.

Severe or chronic inflammation can harm your body's tissues, even to the point of causing more damage than the initial injury that triggered the inflammation in the first place.

Conditions Treated With Corticosteroids

Corticosteroids are often used to help manage nerve root pain caused by a herniated disc, spinal stenosis, rheumatoid arthritis flare-ups, and other conditions. 

Spinal stenosis, a chronic condition, can be caused by arthritis. The spinal cord lies inside the spine, which is a long tube-like structure formed of bone. And the spinal nerve roots normally pass through the foramen (tunnel-like openings in the bone throughout the length of the spine). The spine or the foramen can narrow due to bone spurs or other growths. When the spurs and bone growths come into contact with the nerves, irritation, pain, and/or other symptoms may result. 

Nerve route irritation is also a symptom of a herniated disc and degenerative disc disease; spinal epidurals are commonly given for these conditions, as well.

Safety and Effectiveness

Most of the time, an injection of steroid medication into your spine is safe, and in the short term, may be an effective way to relieve your pain. However, especially with long-term use, side effects are possible and can include:

  • Increased appetite
  • Weight gain
  • Mood swings
  • Blurred vision
  • Increased risk of infection
  • Muscle weakness
  • Acne
  • Osteoporosis
  • Worsened diabetes
  • High blood pressure
  • Restlessness
  • Cataracts or glaucoma
  • Stomach irritation
  • Flushing in your face and chest along with a temporary increase in body temperature
  • Problems sleeping
  • Water retention
  • Anxiety
  • Menstrual changes

More rarely, you might actually have an increase in your pain for a few days. 

Serious complications are rare and can include:

  • Allergic reaction
  • Nerve damage
  • Paralysis
  • Infection
  • Bleeding

By the way, don't let the term "steroids" mislead you; corticosteroids are not the same drug many elite athletes take to improve their game.

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Article Sources
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  1. Pountos I, Panteli M, Walters G, Bush D, Giannoudis PV. Safety of Epidural Corticosteroid InjectionsDrugs R D. 2016;16(1):19–34. doi:10.1007/s40268-015-0119-3

  2. Huntington's Outreach Project for Education, Stanford University. Glucocorticoids. Published February 7, 2011.

  3. American College of Rheumatology. Spinal Stenosis. Updated March 2019.

  4. Johns Hopkins Medicine. Epidural Corticosteroid Injections.

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