Cortisone for Back Pain

Cortisone is a hormone naturally produced by the adrenal gland when the body is under stress and is an important chemical for reducing inflammation. Synthetically-produced cortisone is often injected into the body's soft tissue, areas surrounding joints and tendons, or the epidural regions of the spine to provide short-term relief of tendon and joint discomfort, or pain in the next and back. According to Gerard Melanga, MD, 60 percent of patients require just one cortisone injection to experience some degree of beneficial pain relief.

Epidural Steroid Injection

• Although there are three main types of cortisone injections, doctors prescribe the epidural steroid injection to relieve back pain. The cortisone steroid, which is different than the steroids abused by athletes, acts on inflamed nerve endings soon after a doctor injects it into the epidural region of the spine surrounding the dura, a sac-like membrane that encloses the spinal cord and spinal nerves. By reducing swelling of the spinal nerves, there is decreased pain associated with conditions such as sciatica, spinal stenosis, arthritis and degenerative disc disease.

Procedure

• Although the specifics of each injection procedure can vary according to the patient and doctor administering the shot, there are some generalities about what the patient can expect. The patient can lie on his stomach, curled on his side, or sit upright on the X-ray table. The doctor then cleans and anesthetizes the injection site and uses a live X-ray, called a fluoroscopy, to help direct the needle to the epidural space. Once there, the doctor first injects a contrast dye to check for needle accuracy and then injects the cortisone solution. After the procedure, the patient rests and is monitored for 15 to 20 minutes before going home.

Advantages and Disadvantages

• The injection, administered at the site of pain, is often a preventative first-step to surgery and can give the patient just enough mobility to proceed with alternative therapeutic and rehabilitative programs. In addition, the outpatient procedure can be performed using a local anesthetic giving almost immediate relief with minimal side effects. Nervous patients might require IV sedation during the procedure, resulting in a longer recovery time following the injection. Some soreness and local bleeding might occur, as well as a temporary increase in the initial pain. Disadvantages of long-term use of cortisone injections might also include weight gain, increased blood pressure and decreased bone density.

Risks

• Patients who should not have a cortisone injection are those suffering from a local or systemic infection, pregnant women, or those with any type of bleeding disorder or taking blood-thinning medications. People who should be cautious when considering the procedure are those who might be allergic to the cortisone solution, have existing heart conditions or have an ongoing medical condition such as diabetes or kidney disease.

Considerations

• Although the pain relief associated with cortisone injections can last anywhere from a month to one year, it is still only a short-term solution to what might be chronic pain. Rarely do cortisone injections alone "fix" the underlying problem. When appropriate, patients should use them in conjunction with some type of therapeutic program to receive maximum benefits.