Should You Get a Cortisone Shot for Low Back Pain?
Should you get a cortisone shot for low back pain? Many patients come to our alternative medicine clinic in... Read More ››
Cortisone Injections (also know as Corticosteroid Injections or Cortisol Injections) can be effective at reducing pain associated with inflammation.
Cortisone is an anti-inflammatory medication that mimics the effects of a naturally existing hormone in our bodies known as Cortisol. Cortisol is released by the body during times of emotional stress or injury. Most spine injections, back pain injections, and arthritis injections involve corticosteroids. Prolotherapy is a type of injection but does not use corticosteroids.
Blocking inflammation often provides significant, albeit temporary, pain relief. However, inflammation is the primary healing mechanism of the body. Inhibiting the inflammatory process with cortisone injections or anti-inflammatory medications (Advil, Motrin, Ibuprofen, Aleve, etc.) can delay or even stop the healing process.
Delayed healing of injured tissue usually leads to the over-accumulation of scar tissue and weakening of the muscles, ligaments and tendons. This can make the injured tissue more susceptible to injury in the future.
Pain following a trauma is often triggered by pressure created by swelling and inflammation. Cortisone Injections reduces this inflammation oftentimes creating significant pain relief. That’s the good news.
The bad news is that pain is also a vital part of the healing process. Pain functions much like a smoke detector. When the detector senses a problem it sends out a piercing alarm to warn anybody in the vicinity that they are in danger. Pressure and pain receptors (nociceptors) also send alarm signals to the brain in the form of pain. The pain is there for a reason – mainly to make sure you don’t participate in any activities that might cause you more harm.
Blocking the pain with Cortisone injections can be compared with taking the batteries out of the smoke alarm – the fire (tissue injury) still rages on creating lots of smoke (inflammation) while the occupants of the house remain unaware and in danger.
If you can’t feel the pain then you don’t know when it is time to stop an activity that may be placing your tendons and other soft-tissues in danger. In extreme cases the tendons, ligaments or muscles can actually suffer a complete rupture. An example of this is when basketball great Wilt Chamberlain ruptured a tendon after several Cortisone injections.
When the healing process in interrupted, interfered with or stopped, the result is more than just a delay in healing. The quality of the injury repair suffers in nearly every circumstance. Healing damaged connective tissue is a race against time. Both inflammation and the tearing of nearby blood vessels drive the building materials necessary for healing to the injured area. When the healing is nearly completed phagocytes (microscopic garbage collectors) consume any unnecessary debris leftover from the repair process. If the healing process proceeds without interruption then the phagocytes do a great job and leave very little scar tissue when they leave. Cortisone injections can slow this process to such a degree that more debris is created than can be cleared away leaving a large (macroscopic) pile of scar tissue.
“Doctors tell you that steroids (cortisone, prednisone) only cause side effects after many years. But new research shows that permanent damage is immediate and devastating. Studies show that steroids cause permanent, debilitating effects after a single dosage. Steroids are probably the most sleazy of modern day medications.”
John Mills, former professor of medicine at the University of California, San Francisco and chief of infectious diseases at San Francisco General Hospital.
In #3 we learned that Cortisone Injections create more scar tissue than is necessary for proper healing.
Why is this important? It is important because scar tissue is MUCH less flexible than healthy connective tissue. More flexible healthy tissue can S-T-R-E-T-C-H farther before tearing while less flexible scar tissue will TEAR relatively easily in comparison.
Multiple studies in animals have demonstrated dramatic reductions in tensile strength of connective tissue injuries that healed in the presence of Cortisone and other anti-inflammatory medication. Dozens of studies have demonstrated reductions in tissue strength between 22% and 41% on body regions ranging from knee ligaments to abdominal muscles.
Extrapolate that data in to real life and it may not be inaccurate to say that “people receiving a Cortisone Injection in a particular part of the body (low back for instance) may be 22-41% more likely to re-injure the same body part because of the tissue weakening caused by the medication.”
In Reason #2 we learned that pain actually fills an important role in the healing process. The same is true of Muscle Spasm. Muscle Spasms work to physically protect the injured tissue by limiting motion and mobility that would otherwise cause harm. In fact, the terms “Protective Muscle Spasm” and “Muscle Guarding” are commonly used to describe this “protective” role that muscle spasms play.
It is commonly believed that muscles spasm due to direct trauma or injury. Although this does happen, it is far more common for both pain and the pressure of inflammation to trigger this protective response. Cortisone Injections generally reduce inflammation which, in turn, alleviates pain. This tends to lessen the “warning signals” that the body relies upon when deciding whether to spasm up a muscle defensively or not.
Without protective muscle spasm the injured body part is now prone to further injury from actions that would normally be prevented by their efforts. Further injury is always associated with delayed healing, increased accumulation of scar tissue and less complete recovery. (Can you say ‘vicious cycle?’)
Part of me has a hard time even bringing this up but it is extremely relevant to this conversation. If you live in Denver, chances are you knew or heard of Leslie Fishbein, a prominent business woman here in the Denver, Colorado. She suffered from chronic back pain. She received a bak pain injection and had a “serious reaction,” that caused her to later be placed on life support. Two weeks later, she died.
Shane Ellison, M.Sc a medicinal chemist in Santa Fe, New Mexico was asked to comment on how this could have happened…
“Could have been any number of steroids – likely cortisol – or opioid mimics that killed her. Happens all the time. This time it was a celeb, so we hear about it…People need to stop letting physicians stab them.”
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