Got A Steroid Injection? How About Some Joint Decay With Your Pain Relief?

A new study confirmed something I've suspected for some time. Getting a shot to relieve pain may not resolve the issue.

CNN reports that 8% of patients receiving steroid injections may have serious side effects from them. But they go on to say that it's really about patient preference. Sure, you might need to get a knee replacement later, but you'll have less pain now.

Really? Patients are qualified to make that sort of long-term, life-changing decision? Isn't that what we have doctors for? If my mechanic asked me if I wanted sawdust injected into my engine because it would help it run smoother now but I might need another engine later, I wouldn't know how to make that decision. How is a patient supposed to decide if the short term benefits outweigh the long term risk? That's why they pay the doctor the big bucks. Claiming that it's patient preference really means that doctors can keep racking up the injections until research proves conclusively that patients are really being harmed.

The advantage of steroid injections for pain are that it's fast and convenient. Compared to physical therapy, the outcomes were about the same for shoulder pain. But add in the risk of joint deterioration from the shot, and the advantage goes to physical therapy. For carpal tunnel, the shots were about the same as surgery or splinting.

Dr. Manuel González Reyes from Pixabay 

But the big money maker is corticosteroid injections for osteoarthritis. Especially for knee pain. So let's go beyond the possibility that your knees might need to be replaced sooner. The most recent analysis of steroid injections for knee pain was published in 2018. It concluded that there wasn't much data, but patients had "improved pain relief and physical function." So bring on the shots, right?

Not so fast. That article was retracted. To be retracted, you have to be really out of line. If you read the retraction notice of the article, the authors didn't use all controlled trials. The two trials they did use showed no benefit for steroid injections over placebo. 

OK. Now it's pretty clear. Studies show no benefit from the shots over placebo or other treatments, and other studies show that the shots may cause permanent damage. So why are the shots still being given at all? The answer may lie in the almost miraculous pain relief some patients experience from the shots. I'm suspicious that much of this is the expectation of benefit, but let's assume that doctors will continue to use something that gives even a few patients some relief.

There's a simple answer. Stop giving steroids and start injecting something much less dangerous like hyaluronic acid. It the big analysis, it outperformed steroids for knee pain. Other studies show pain relief. Patients can still get their injections, and nobody has to lose a knee.

But there's also a better answer. Treat the cause of the problem rather than just injecting the inflamed area. In my book about Chronic Back Pain I go over all the common treatments for back pain. All of them give short-term relief. But patients can get long-term relief by looking at their habits and altering them. The alteration of poor habits is the only way to really avoid pain over a lifetime.