Cortisone Injections for Back Pain

Doctors may order injections for back pain or joint pain either as an adjunct to other treatments, such as physical therapy, or when other more conservative treatments have been unsuccessful at providing relief. Cortisone injections, like steroidal anti-inflammatory drugs, involve the delivery of steroids to prevent inflammation around damaged or degenerated joints. In many cases, the inflammatory process is beneficial to damaged muscles, bones, and soft tissues, because the process involves the an increase in the flow of blood and nutrients to the damaged areas to accelerate the healing process. But along with the increase in blood flow, pain, swelling, and reduced mobility are other by-products of the inflammatory process. With certain musculoskeletal conditions, such as osteoarthritis, the inflammatory process may continue indefinitely, despite the fact that there has been irreversible damage done to the joints, such as cartilage loss. There have been no serious research studies that indicate that lost cartilage can be re-grown, despite the proponents of various nutritional supplements claiming that they can do so. To prevent or inhibit the inflammatory process, NSAIDs and steroidal medications block the cells around injured joints from releasing leukotrienes and prostaglandins. Medications taken orally, are absorbed into the bloodstream, thus affecting the cells around the injured joints as well as body structures throughout the body. This type of systemic delivery may cause psychological as well as physical side effects such as high blood pressure, osteoporosis, mood swings, stomach ulcers, and increased susceptibility to infection.

Cortisone injections for back pain, on the other hand, are steroid injections that are delivered directly to the joint, muscle, or soft tissue that is thought to be the main pain generator. The pain generator is an important concept for you and your doctor to understand, because many cases of pain conditions involve referred pain - which is pain that is felt in one area of the body but is experienced in another. Because the delivery of the cortisone injection involves the delivery of the medicine into a specific area of a joint, this treatment may be used as a diagnostic tool, as well as a therapeutic treatment. If the treatment works, then the doctor will know that that area is specific the area causing your pain or referred pain. Steroid injections are particularly effective in treating conditions that involve chronic moderate to severe inflammation, such as bursitis or osteoarthritis.

There are several benefits, as well as side effects, associated with cortisone injections. Here are some of the benefits.

  • If successful, corticosteroid injections may provide immediate and lasting relief. Many patients who receive these treatments reporting feeling better by the time they leave the pain clinic. Some patient report significant pain relief for up to a year after receiving a treatment.
  • The injections may be helpful as part of a broader treatment program. Often, patients with severe back pain, or those recovering from surgery for back pain must endure a grueling exercise program in order to regain strength in their back and core muscles. This physical therapy may involve patients having to feel worse before they finally feel better. The temporary relief provided by steroid treatments may enable some patients to be able to continue their rehabilitative program.
Here are some points to consider against having cortisone injections for back pain.
  • Only about 50% of patients who receive these treatments experience pain relief.
  • There is always the risk of infection associated with needle injections.
  • Repeat injections may eventually cause bone loss or weakened ligaments and tendons.