Are steroid shots for neck and back pain safe?

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The American Chiropractic Association estimates that 80% of the population will have a back problem at some point in their lives.  Despite the lack of solid effectiveness evidence, spinal injections for back pain, in a procedure known as lumbar epidural steroid injections (ESIs), has become quite common.  The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Most practitioners will agree that, while the effects of the injection tend to be temporary, providing relief from pain for one week up to one year.  Importantly, an injection can provide sufficient pain relief to allow a patient to progress with a rehabilitative stretching and exercise program.  Unfortunately, many of these injections are either not considered medically necessary under current guidelines or have insufficient documentation about the need for the shot.  So what are the risks associated with getting these steroid shots, and is it safe?

Side effects and Risks of ESIs

As with all invasive medical procedures, there are potential risks associated with lumbar epidural steroid injections.  Lumbar epidermal steroid injections are not without serious risks.  In rare cases, for example, the injections can cause arachnoiditis, an incurable and extremely painful condition in which scar tissue forms in the spinal column, binding the nerves together.

In addition to temporary numbness of the bowels and bladder, the most common potential risks and complications include:

    • Infection. Severe infections are rare, occurring in 0.1% to 0.01% of injections
    • Dural puncture ("wet tap"). A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days.
    • Bleeding. Bleeding is a rare complication and is more common for patients with underlying bleeding disorders
    • Nerve damage. While extremely rare, nerve damage can occur from direct trauma from the needle, or from infection or bleeding

Side Effects from the steroid medication are less prevalent than the side effects from oral steroids and can include:

·         Localized increase in pain

·         Non-positional headaches resolving within 24 hours

·         Anxiety

·         Facial flushing

·         Sleeplessness

·         Fever the night of injection

·         High blood sugar

·         Transient decrease in immunity

·         Stomach ulcers

·         Severe arthritis of the hips

·         Cataracts