Lately, many patients with chronic pain, including those with back pain, shoulder rotator cuff pain, elbow tendinitis pain or other chronic pain, have been asked by their family doctors ‘if they would prefer corticosteroid injections to physiotherapy?’
A Henry Ford Hospital, in Washington, D.C., study ( http://t.co/W3gj4dJt ) has found that postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief.
Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn’t receive steroid injection, researchers said.
Shlomo Mandel, M.D., an orthopedic physician and the study’s lead author, said physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.
“The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility,” Dr. Mandel said.
“Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient’s treatment plan,” he added.
Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.
Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.
There has always been the link, and the questions concerning steroid injection and tendon or bone deterioration. One of the more famous cases was that of Joe Montana, Hall of Fame NFL quarterback and his elbow tendon rupture following multiple injections. Now there are not many of us that perform at this level, but chronic pain of any type can be debilitating and life altering. Please know your options and be aware of all the side effects associated with longterm medications; the list of side effects may outweigh any medical advantage.
If you are considering steroid injection as a form of treatment; ask your doctor about his/her experience in delivering such a treatment option. An orthopedic surgeon or experienced sportsmedicine doctor would be a wise choice.
Your Physiotherapist should be able to address your concerns about such a treatment option, and he/she should be able to provide treatment relevant to your pain trigger points and the appropriate exercise to assist in your longterm rehab.
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