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Injections vs oral steroids?

AnonymousUserAAnonymousUser Posts: 49,899
edited 06/11/2012 - 8:33 AM in Spinal Injections
Hi there -
My doctor is recommending cervical epidural cortisone injection(s) for my neck and shoulder pain. I haven't gotten much relief from NSAIDS, and my nerves are too inflamed and reactive to tolerate physical therapy.

I'm wondering why the doctor isn't considering a course of oral steroids instead. It seems like that would be much less invasive, and my physical therapist thinks it would be likely to help. When I've mentioned oral steroids, the doctor has sort of skated over the issue and gone straight for the shots... I know that this may be partly due to my not knowing enough to ask the right questions, and also to my pain getting in the way of my ability to think straight.

I will be seeing the doctor again soon. Any information, opinions, or advice?

Thanks,
Liz
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Comments

  • dilaurodilauro ConnecticutPosts: 9,719
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    ________________________________________________________________________________
    Spinal Injections involve a lot more than what oral steroids can provide. I am giving you two links from Spine-Health so you can watch a video on the injection and read the details:

    ESI Video
    ESI Details

    Where is your pain, have you had any formal testing, MRIs, CT Scans, etc?

    Besides what the medical books will tell you , I look at three level of cortisone(steroid) deliverable:

    1- Oral - Predisone and other Steroids. Effective for mild to moderate inflammation.

    2- Cortisone Injections - These are the types normally given into the Knee, Shoulder or Spinal Area. Effective for short to mid term pain relief and very effective in reducing inflammation.

    3- ESI Epidural Spinal Injections - These types go deeper than what other injections can do and are performed normally in operating room like surroundings. The doctor is guided with a fluoroscope to ensure that the injection is being delivered to the correct area.

    Over the years, I have had all three types, multiple times. I have had the best luck with Cortisone Injections 100% of the time I got relief. With the ESIs, I had about 7 or 8 and I got relief from 3 of them.

    In all of these situations, the treatment may be considered a band aid approach. For some it may be enough to keep them pain free for years, for others it might just buy them some time.

    Read up all of these to see what sounds right for you. But most importantly and should ALWAYS be considered the formal response is what your doctors are telling what to do.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I think the simple answer is that oral steroids must travel through your whole body and be processed by various organs, while the injection will go directly to the area that needs to be treated. It is a much more direct, localized way to deliver the medicine to the affected area.
  • Prior to receiving multiple ESI's I had taken the Medrol dose-pack on two separate occasions for back related problems. The oral steroid medication did absolutely nothing for the inflamation near the pinched nerve and the pain that I felt in my leg.

    However, the oral steroid meds (that I was taking for the back problem) DID help with the pain that I was having on a tooth that ultimately needed a root canal! B)
  • Thanks for your replies.
    I'm going in for the ESI on Tuesday with relatively high hopes. It's amazing to me that I'm actually looking forward to it. Just a month or so ago I was a full-fledged needle-phobic, panicking over getting blood drawn. But I mean, how much can a needle hurt compared to a whole mess of angry nerves? ;) At this point, anything that relieves the pain and swelling is my friend.
  • My doctor gave me a medrol pack to take b/c the first shot didn't work- it's only been 72 hours, so could it be dangerous that I have 'too many' steroids in my body? The Medrol pack worked for me when I FIRST was injured but I had worked out and trained hard right after b/c I didn't know the reason I felt good was just the steroids- therefore, she thinks they may help me more if i'm taking it easy while taking them. Any thoughts?

    Thanks!

    Jamie :)
  • Usually doctors recommend waiting at least a week, sometimes two, before evaluating the success or failure of a corticosteroid injection. The relief felt in the first day or so is mainly related to the anesthetic injected along with the steroid, and the anti-inflammatory effect continues to develop over the following week or so. It seems like starting an oral steroid would make it difficult to tell how effective the injection was.

    My other thought is that the Medrol pack is just not as strong as the injection, so it kind of seems like putting a band-aid over stitches... and I think you're right to be concerned about having too much steroid in your body at the same time. Have you asked your doctor about this? NEVER be afraid to ask questions! Remember, it's your body.
  • mdouglasmmdouglas Posts: 2
    edited 07/14/2015 - 4:16 AM
    I'm having the opposition situation. My dr. Prescribed oral steroids I took for about a week and the initial ridiculous pain subsided along with the spasms . But 6 weeks later I still can't do much walking. I go to pt and take Motrin. I'm getting concerned of the problems that NSAIDs cause. after much research I called asking for a cortisone shot. Since I think my inflammatory response in my nerves is out of control. He wouldn't give it to me but is instead referring me to a pain management dr where I can maybe get the shot. I'm so frustrated. I go Wednesday and I pray he gives it to me. Is there any harm in having this shot after a round of steroids? I'm willing to endure this pin because the pain on my leg and quality of life is diminished. I used to be extremely active where people sought my advice on fitness and lifestyle. Now I do nothing . And it's hard not to get depressed. I'm 36 year old healthy in shape woman and this is killing me .


    Moderator's message...Please click on link for helpful information
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    M Douglas
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