Steroids for Chronic Back Pain Relief

Do you have persistent back pain? If so, performing your usual activities and doing your tried and true exercise routine (if you have one) may be may fueling chronic inflammation by constantly irritating the affected area.

Corticosteroids can be injected right into the inflamed area to alleviate the pain and swelling, and to reduce the activity of the immune system. Steroids are often given when more conservative type treatments fail to relieve pain, but before surgery is attempted. Corticosteroids can also be taken orally, in pill form. (Ask your doctor about which form is best for you.)

That said, a steroidal injection for back pain (the spinal epidural) is the most common type of treatment given for back pain caused by irritated spinal nerve roots. In the low back, people often refer to this condition as sciatica.

How Do Corticosteroids Work?

Corticosteroids work by blocking and reversing the damaging the effects of inflammation. (Inflammation is an immune-system activity.) Specifically, corticosteroids inhibit the production of prostaglandins, as well as other chemicals. To do that, the steroids simulate the hormone cortisol, which your body produces naturally in the adrenal glands (small glands that sit on top of each kidney.)

You might think of your immune system as your personal army sent out to protect an affected body region from an invader. When you are injured, the insult to your body stimulates the immune system to release chemicals into the area to mediate the damage and allow you to heal.

When you are injured, the insult to your body stimulates the immune system to release chemicals that both cause inflammation and allow you to heal. But inflammation can quickly get out of hand. When it does, it can harm your tissues, even to the point of resulting in more damage than the initial injury. That's why doctors recommend taking anti-inflammatory medications, such as Motrin (ibuprofen) or aspirin, as soon as possible after an injury. It's also why your doctor may refer you to a specialist for a spinal injection.

Conditions Treated With Corticosteroids

Often called "steroids" for short, corticosteroids are given for nerve root pain caused by a herniated disc (which, as mentioned above, you may better understand as sciatica), as well as for spinal stenosis, rheumatoid arthritis flare-ups, and for other conditions. 

Steroids are quite often used for tough-to-relieve pain due to spinal stenosis. Spinal stenosis is a consequence of arthritis where areas through which nerves (and even the spinal cord) become narrowed due to bone spurs. When these spurs and bone growths come into contact with the nerves, irritation, pain and/or other symptoms may result. Spinal stenosis is a chronic condition. 

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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