Steroid injections: Top 10 questions asked by new patients
Many new patients who come to me have already seen a number of doctors for their back and leg pain. Often they have tried medications (pills, lotions, patches), physical therapy, chiropractor visits, or acupuncture. Many have also received injections for pain.
Here are their most common questions:
1. In the past, I had “cortisone shots.” Do I need these again?
It depends. When many people say they have had cortisone, they are referring to epidural steroid injections to the back. However, doctors can put this medication in a number of different areas in the spine (see article types of back pain). Your personal pain story, physical exam, and MRI/CT all help your doctor to figure out which of these locations is the best target to help your symptoms.
2. Will you give me the same injection I had before?
It is always helpful to know what you have tried before. However, we are confident in our ability to find the most effective injections for our patients. This may or may not be the same thing that was done in the past.
3. Will you do the procedure the same way as my other doctors?
There are a number of different “approaches” to injections, and it is our job to determine which has the best chance of success. You may receive an “interlaminar” epidural, a “transforaminal” epidural, or a “caudal” epidural injection, which is tailored to your specific pain.
5. How much will it help my pain?
We are always happy if pain scores drop as low as possible for our patients! In many cases it is just as important if your lifestyle and activities change as well. For example, if you can walk farther without sitting or if you are able to be busier doing what is important to you.
6. How long does it take to work?
Most injections include a steroid to help with inflammation, and a local anesthetic numbing medication. The numbing medication should work quickly, but steroids can take 3-5 days to kick in. For some patients, even a few weeks. This is why we often schedule your follow-up 2 weeks later.
7. How long does the relief last?
All patients are different. In general, we hope they last at least weeks to months. Some people have very few flares, meaning that they may need only one injection over a long period of time.
For many people, the changes in their back are gradually getting worse, meaning that they may need a few injections every year to control their symptoms.
8. What are the risks?
The risks are extremely low. However, anytime a needle is used, there is always a theoretical chance of bleeding, infection, nerve injury, and reaction to the medication. To make the risks as low as possible, it is important that we know your medication list, including blood thinners. We have to make sure you have no infections and take no antibiotics. During the procedure, we have many safety protocols, including use of an x-ray machine (fluoroscopy), contrast medication (to make sure the needle is in a safe position), and sterile preparation.
9. How many injections can I get?
Every patient is different. Generally speaking, patients can have about 3 – 4 injections safely a year. The steroid medications can increase blood sugar so we must be careful in patients with diabetes. They can also temporarily change how your body fights infection, which is another factor. If a patient receives too many steroids, there can be tissue weakening. As a result, we keep track of your procedures and try to give them when your pain is the most bothersome.
10. Will we have to do it again?
We will decide at your follow-up. If you have a partial response, it is possible we would consider a repeat. However, if your pain has changed, we may need to think about other procedures that are more appropriate.