Considering a corticosteroid injections for chronic pain?

Chronic pain can be a significant barrier to leading an active and fulfilling life. For many, the discomfort can make it challenging to engage in the very activities that might promote healing, such as physical rehabilitation exercises. At Pittwater Chiro, we advise a trial of conservative care for most injuries, aches, or pains. However, if you’re stuck in a rut and think there might be other options for alleviating your pain, then corticosteroid injections may be recommended.

What are corticosteroid injections?

Corticosteroid injections are a prevalent non-surgical treatment option for various musculoskeletal conditions, providing significant pain relief. These injections utilise corticosteroids, such as dexamethasone and triamcinolone acetonide, to reduce inflammation and improve function in affected areas. Your GP will determine the site of injection based on your symptomatology and the specific condition being treated. Imaging techniques, such as fluoroscopy or ultrasound, are often used to ensure accurate placement of the needle.

Common conditions where corticosteroid injections may be recommended include tendinitis, bursitis, or spinal conditions like herniated discs. While effective, the implications of corticosteroids short-term and long-term warrant careful consideration. The effects of corticosteroids are not permanent, but they can last for weeks or even months, depending on the condition and individual response.

If there’s a risk, what’s the reward?

One of the key benefits of corticosteroid injections is their ability to mask pain enough to enable you to do your rehabilitation exercises. Chronic pain often creates a cycle where pain limits movement, leading to muscle weakness, stiffness, and further pain. By providing temporary relief, corticosteroid injections can help break this cycle.

With reduced pain, individuals can focus on strengthening muscles, improving joint stability, and restoring mobility through a carefully designed rehabilitation program. This approach not only addresses the immediate symptoms but also targets the root causes of chronic pain, aiming for long-term improvement. For more information on the benefits of exercise rehabilitation, read Jess’s blog.

Are corticosteroid injections right for you?

It’s important to note that corticosteroid injections are not a cure for chronic pain or its underlying conditions. They should be seen as a tool that allows for more flexibility within a broader treatment plan. Ideal candidates are individuals who:

• Experience chronic pain that significantly limits their ability to function or participate in rehabilitation.
• Have inflammation-related pain that has not responded to conservative treatments like chiro/physio or over-the-counter medications.
• Are prepared to combine temporary pain relief with a structured rehabilitation program.

Limitations and Risks

While corticosteroid injections can be effective, they come with limitations and potential risks. This is why these are not recommended as a first line of treatment and you should consult your GP if this is an option you are considering.

Overuse of these injections can weaken tissues which may cause further dysfunction and pain, and in some extreme cases can lead to ruptured tendons or ligaments. These injections can also lower your immune response, which increases the risk of infection especially if they are applied before other surgical interventions. The relief they provide is temporary, and repeated use should be carefully managed by a healthcare professional.

Following a corticosteroid injection, several recommendations are crucial to optimise recovery and minimise potential adverse effects. These include:

• Initial Rest: It is recommended to rest the affected joint for 1 to 2 days post-injection to reduce systemic absorption and damage to the cartilage near the site of injection.
• Gradual Increase in Activity: After the initial rest period, a gradual increase in activity is advised to maximise the injection’s benefits.
• Limitations on Frequency: It is generally advised not to exceed three injections within a 9 to 12-month period to avoid diminishing returns and increased risks.

Building a Long-Term Strategy

Chronic pain management is most effective when approached holistically. Corticosteroid injections may serve as a stepping stone toward recovery, but sustainable improvement requires a commitment to lifestyle changes, such as:

• Consistent participation in physical therapy or guided exercise programs.
• Addressing contributing factors like work ergonomics, overuse, or weight management.
• Exploring complementary therapies like chiro/physio, acupuncture, or yoga.

Corticosteroid injections can be a valuable option for individuals suffering from chronic pain, particularly when the pain hinders progress in rehabilitation. By providing temporary relief, these injections can pave the way for effective rehabilitation and long-term recovery. If you’re considering this treatment, consult with your GP to develop a comprehensive understanding and plan.

References A

1. Honorio, T., Benzon., Dalia, Elmofty., Hariharan, Shankar., Maunak, V., Rana., Andrea, L., Nicol., Shalini, Shah., Dmitri, Souza., Ameet, S., Nagpal., Salahadin, Abdi., Christian, Rafla., Alaa, Abd‐Elsayed., Tina, L., Doshi., Maxim, S., Eckmann., Thanh, D., Hoang., Christine, Hunt., Carlos, A., Pino., Jessica, Rivera., Byron, J., Schneider., Alison, Stout., Angela, Stengel., Maged, Mina., John, Fitzgerald., Joshua, A, Hirsch., Ajay, D., Wasan., Laxmaiah, Manchikanti., David, Provenzano., Samer, Narouze., Steven, P., Cohen., Timothy, P., Maus., Ariana, M., Nelson., Harsha, Shanthanna. (2024). Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections – guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society. Regional Anesthesia and Pain Medicine, rapm-105593. doi: 10.1136/rapm-2024-105593
2. Katie, J., McMorrow., Sachin, Allahabadi., Landon, P., Frazier., Ryan, J., Quigley., Brian, Serrano., Brian, J., Cole. (2023). One to Two Days of Rest Is Recommended Before Returning to Sport After Intra-Articular Corticosteroid Injection in the High-Level Athlete. Arthroscopy, sports medicine, and rehabilitation, 5 doi: 10.1016/j.asmr.2023.100763
3. Christine, Bilsborough, Smith., Dave, Baker., Rajesh, Botchu., Melinda, Cairns., Rachel, Chester., Benjamin, Dean., Robert, Mast., Jeremy, Lewis. (2023). Corticosteroid injections for non-spinal musculoskeletal conditions: Consideration of local and systemic adverse drug reactions and side effects. The New Zealand journal of physiotherapy, doi: 10.15619/nzjp.v51i3.363

References B

1. Helen, Gharaei. (2015). Epidural Steroid Injection Warning & Safety Recommendations. Journal of Anesthesia & Critical Care: Open Access, 2(5) doi: 10.15406/JACCOA.2015.02.00069
2. Zoë, J, Foster., Tyler, Voss., Jacquelynn, Hatch., Adam, Frimodig. (2015). Corticosteroid Injections for Common Musculoskeletal Conditions.. American Family Physician, 92(8):694-699.
3. Sean, Hazzard. (2023). A Comparison Review of Various Corticosteroids in the Orthopaedic Setting for Various Injections. Journal of orthopedics for physician assistants, 11:e23.00003-e23.00003. doi: 10.2106/JBJS.JOPA.23.00003
4. Adnan, Saithna. (2024). Editorial Commentary: Corticosteroid Injections Administered Within 4 Weeks Before Shoulder Arthroscopy Are Associated With an Increased Risk of Infection. Arthroscopy, 40(2):284-286. doi: 10.1016/j.arthro.2023.10.006