Low Back

Joint Injections and Side Effects: PRP and Stem Cells are Safer Than Steroids

By Last updated on April 5, 2020 Last updated on April 5, 2020 No Comments

DO YOU HAVE LOW BACK PAIN?

Joint Injections and Side Effects

Joint pain is one of the most common types of chronic pain faced in the United States. Whether joint pain is being caused by natural degeneration of cells or from an injury, individuals faced with it can experience an inability to perform daily tasks, trouble sleeping, and a generally lower quality of life.

The good news is that there are plenty of treatment options available for joint pain because it is so common. It is important to weigh all the treatment options available before proceeding with them.

The most popular treatment for joint pain is corticosteroid injections. They are popular because they are effective in treating pain. There are many risks associated with them that need to be considered along with the benefits.

Many studies have concluded that they can weaken tissue over time, leading to worse pain. There are other treatment options in the world that offer an alternative way to not only deal with joint pain but treat it. This article will provide information about corticosteroid injections – what they are made of, when and why they are prescribed, and the side effects.

It will also provide information about alternative therapy for joint pain called regenerative medicine. Being knowledgeable about the treatment options allows patients to make well-informed decisions.

What Joint Injections Are Made of?

Steroids have been used to treat pain for over fifty years, though it was only recently that we have begun to understand why – and become aware of the risks associated with steroid injections. The type of steroid used for these injections is not the same as that are commonly heard of and controversial within sports.

The steroids used for these types of injections are called corticosteroids (sometimes referred to as just “steroids” for short) and are synthetic. They are created to resemble cortisol, a naturally occurring hormone in the human body. Cortisol is made in the adrenal glands and affects these processes:

  • Reduce Inflammation
  • Regulate Blood Sugar and Metabolism
  • Regulate Blood Pressure
  • Regulate salt and water balance

Almost all cells in the body contain cortisol receptors, so it can have effects throughout the body. Corticosteroids are focused most on the anti-inflammatory properties in cortisol and do their best to mimic it. As the body naturally produces cortisol and is generally receptive to it, most patients’ bodies do not reject corticosteroids.

What are Corticosteroid Injections?

Doctors will likely recommend steroid injections for patients dealing with inflammation. This can be anything from arthritis to tendonitis, disc herniations/slipped discs, and many more. Chronic pain is often associated with inflammation throughout the body.

Injecting a steroid into the problem area can offer patients a reprieve from the pain. They are typically injected into joints, in the bursa. The bursa is a fleshy sac whose function is to provide a cushion between bones in a joint.

Administration of corticosteroids may involve an application of a local anesthetic to numb the area where injections will go. Patients also have the option of going under full anesthesia, but due to time constraints and cost this is not typically done.

Doctors use imaging technology such as X-Rays to locate the area where injections will go. Contrast dyes are sometimes applied to further pinpoint the location where shots need to go. Contrast dyes are often used along with X-Rays for accuracy.

Corticosteroid injections are popular with doctors because of their convenience and ability to help patients even if it is short-term. Many patients can better complete physical therapy when it is coupled with corticosteroid injections, as well as go back to work quickly.

The recovery process for these types of injections typically involves a bit of rest, but as soon as the pain has subsided, patients can go back to normal activities. The injections themselves do not take long to administer – usually less than an hour – and some patients see results within minutes.

Some of the feelings of being pain-free immediately after the injections are because of the localized anesthetic that is applied before the procedure. Relief from the corticosteroids comes usually within a matter of hours or days depending on the patient.

Generally, corticosteroids are administered as a part of a greater treatment plan that has been formulated by experts to provide the best possible recovery, designed to meet each patient’s specific needs.

Treatment Factors and Plans

Doctors are constantly weighing the pros and cons of treatment. This applies to drugs prescribed, suggested exercise, surgery options, and so many more. It is their job to consider a patient’s full profile and ability when making the decision to create a treatment plan. Factors which might affect the treatment plan include:

  • Age: soft tissue deteriorates over time, so a doctor is more likely to consider corticosteroid injections in elderly patients in cases where tissue damage has already been done.
  • Fitness level: overall fitness level can impact the strength of the muscles surrounding an injury and provide structure to it while it heals.
  • Family history: a history of conditions such as arthritis or hip dysplasia will affect treatment plans.
  • The job of the patient: if a patient’s job involves physical activity such as a mover or construction worker, this will affect the treatment plan as well. Repetitive motions can contribute to more rapid degeneration.

When discussing treatment with a doctor it is important, to be honest, and give as much information as possible. Many doctors have the tools necessary to help the patient in the best ways possible, and their toolkits expand with more information.

Steroid injections are often marketed as a safer and less invasive alternative to surgery. Patients with chronic pain often go through some form of a treatment plan with their doctors before facing the options of injections or surgery. This plan includes:

  • Rest: often the first step in reducing chronic pain is attempting to rest. In many cases, the body can heal itself from an injury such as a tear in tendons or muscle. It is also recommended in this stage that the patient apply ice as directed to help with pain and inflammation.
  • Anti-Inflammatory NSAIDs: rest is often accompanied by over-the-counter anti-inflammatory medication such as Ibuprofen or Naproxen. These work by distributing a small number of anti-inflammatory properties all over the body, whereas corticosteroid injections place a large concentration of these properties in one area.
  • Physical Therapy: if a couple of weeks of rest and attempts to reduce inflammation are unsuccessful, doctors will refer patients to a physical therapist who will be able to create a plan for the patient. Physical therapy seeks to restrengthen muscles, improve mobility, and provide structure to the injury.

If these treatments aren’t working well enough, doctors may suggest corticosteroid injections as the next step. Their main goal is to stop the pain, which will theoretically improve a patient’s enjoyment of life. Doctors often offer steroid injections when the only other option is surgery.

These are very commonly used – over 9 million are done annually. They offer patients temporary pain relief and postponing of more invasive surgeries, which can greatly impact the enjoyment of life. Some patients prefer to take time before deciding to undergo surgery, and corticosteroid injections can offer a solution to chronic pain while that decision is being made.

Benefits and Risks of Corticosteroid Injections

Corticosteroid injections offer a few benefits to patients who choose to undergo them. These include:

  • Pain relief
  • Reduced inflammation
  • Increased function of joints
  • Ability to return to normal activity levels

This form of treatment has the potential to reopen the door to an active and enjoyable lifestyle. There are several risks that should be taken into account when deciding to undergo any procedure, however.

The risks of injection alone can include increased pain or infection. Adding what is actually in the needle, the risk increases greatly. For corticosteroid injections, these risks include:

  • Stroke: if the injection is placed into the bloodstream instead of the targeted area, the steroids can potentially reach the brain, causing a stroke.
  • Cortisol Disruption: an influx of cortisol is likely to disrupt the natural processes that cortisol is responsible for, as well as potentially disrupting the body’s ability to produce it.
  • Blood Clots: people who are on blood-thinning medication are recommended to stop taking them before receiving a corticosteroid shot. Corticosteroid injections also have a chance of thinning the blood, which can lead to blood clotting in the wrong areas.
  • Nerve Damage: there is also a risk of the nerves surrounding the injury to become damaged, which can help with pain but creates a permanent sensation of numbness in the area.
  • Not Healing the Injury: these shots offer a short-term solution to the pain. They make no promise of healing the underlying issue, only resolving relief from pain during daily activities. The shots only last for a couple of months, so patients who receive injections often have to return for more shots, which can lead to even bigger issues.
  • Tissue Damage Over Time: when shots are administered too frequently or over a long period of time, it can damage tissue. This includes cartilage, which holds together joints, or tendons, which hold bones together. These pieces of soft tissue are vital to the functionality of our bodies and without the proper structure will begin to fall apart. It is much riskier to administer these shots to patients who are healthy and young, as their joints have not yet begun to deteriorate. These shots can speed up the natural deterioration process and lead to arthritis or other issues in the joints and soft tissues. Doctors who are using safe practices will only administer them every couple of months.

One of the biggest reasons why corticosteroid injections can be dangerous is that they are used incorrectly.

The certification process for doctors looking to perform these injections can be only a couple of days long. This opens the door further to the risks listed above – they are much more likely to happen if the doctor is unaware of how to properly administer medication.

These injections should also only be administered every couple of months to limit the potential degradation of soft tissue. Being aware of the risks is important for a patient to decide how to move forward with treatment.

Though these injections are widely used, they do not offer the potential to treat the injury or help injuries heal in the future. There is a field of medicine, regenerative therapy, which may offer these benefits.

Regenerative Medicine as a Safer Alternative to Corticosteroid Injections

The field of regenerative medicine is rapidly gaining traction in the medical community. Many laboratories and clinics are researching the effects of these treatments every day, giving doctors around the country new insight into alternative therapies frequently. There are two major forms of regenerative therapy offered at CELLAXYS:

  • Stem Cell Therapy: this involves harvesting a patient’s own stem cells from fat cells, blood cells, or bone marrow. Once the cells are extracted they are processed so that they can be reinjected into the location of injury or degeneration. They can call to other cells in the body which contain healing properties and increase the number of cells working to heal the issue.
  • Platelet-Rich Plasma (PRP) Therapy: blood is drawn from a patient and placed in a centrifuge to isolate platelets in the blood from plasma. Platelets contain growth factors and proteins that help the body heal. They are then injected into the source of pain to aid the healing process.

Both types of therapy also use injections. Doctors use imaging techniques, such as MRIs, to know exactly where the needle needs to go and place it there. What they are essentially doing is taking the body’s own healing properties, enhancing them, and placing them in a location where they can do their jobs well.

Regenerative therapies offer a wide array of benefits to patients. Some of these benefits include:

  • Pain Relief: as an injury or degeneration heals, whatever was causing the pain begins to heal too.
  • Long-term Solution: regenerative therapies work well on soft tissue injury or degeneration. Healing properties can help to rebuild soft tissue and bring it back to a former, healthier, state. This means that the injuries are actually healing. Corticosteroid injections only offer pain relief but no healing.
  • No Disruption to Immune System or Hormone Levels: regenerative medicine is using the body’s own healing materials rather than a synthetic hormone. Without an influx of synthetic material, the important systems in the body can continue their normal functions. The risk of infection or adverse reactions is significantly lowered because it is the body’s own tissue.
  • Less Need For Surgery: with corticosteroid injections, the option of surgery can be inevitable, and the injections only offer to prolong it. Regenerative medicine, with its healing abilities, may offer an option to not only delay surgery much further but avoid it altogether.

Though doctors may not initially discuss or recommend regenerative therapies, it is important to keep it on the table during a discussion of treatment. Regenerative medicine can be coupled with certain treatment plans as well, to enhance their properties:

  • Physical Therapy: coupled with regenerative medicine, physical therapy can do an even better job of providing support throughout the body and help muscles to heal faster.
  • Surgery: patients can opt to have regenerative medicine injected after surgery. There is also an option for surgeons to use a special type of string infused with stem cells or platelets. Using this kind of string allows the healing properties of regenerative medicines to interacting even more intimately with the surgical process.

The procedure for receiving regenerative therapy is short, taking generally less than two hours. Patients can expect to begin to feel reduced pain in a matter of hours or days following the procedure. It is sometimes recommended that patients come back for recurrent injections, but unlike corticosteroids, there is no detriment to tissue over time.

Stem cells and PRP therapies are not a cure-all for degenerative conditions or injuries. There are still risks associated with infection and rejection of stem cells. Even if the stem cells are from the patient’s own body, the immune system has a small chance of rejecting them.

All treatment options have risks and benefits, and that can seem overwhelming. It is important to gather information about all the possibilities. Being honest with doctors about concerns can pave the way to a more clear-cut discussion involving treatment plans.

Conclusion

Corticosteroid injections are a widely used anti-inflammatory pain relief. It acts by mimicking cortisone, a naturally occurring hormone. These shots are used frequently because of their convenience and ability to reduce pain levels in patients.

Unlike regenerative therapies, repeated use of corticosteroid injections can lead to weakened soft tissue and damage to cortisol receptors in cells, among many other potential risks. Steroid injections do not offer the possibility of healing an injury or repairing any tissue, but the temporary pain relief can be enough for some patients to partake in them anyway.

The other option, however, has the potential to relieve pain in a similar amount of time and with a similar level of invasiveness. The difference between them is that one can heal and repair cells while it is relieving pain. Healing properties used in regenerative medicine act efficiently to not only relieve the problem – they help to solve it.

Dr. Pouya Mohajer

Dr. Pouya Mohajer

Director of Regenerative Interventional Spine Medicine
Board certification in Anesthesiology and Interventional Pain Medicine
Fellowship-trained from Harvard University
UCLA Alumni

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