I love blogging about my experiences in clinic, especially the ones that make my blood boil. One of those blood boiling issues is steroid injection risks. This past week, while seeing patients at our licensed, advanced stem-cell-culture site in Grand Cayman, I saw a guy whose hip MRI from December wasn’t that bad. In fact, it didn’t fit with his quickly declining function and elevating pain. A quick preprocedure X-ray confirmed what I had feared—two steroid shots he had in that hip a few months back had accelerated his arthritis like pouring gasoline on a bonfire. So this post is aimed squarely at the legions of physicians who continue to use steroids…
Steroid Injection Risks Are Nasty
Physicians around the country inject high-dose corticosteroids in joints like it’s holy water. The dose they use is based more on medical tradition than on science. You see, while the milligram-dose range used sounds small (after all, it’s only a thousandth of a gram), to the body it’s massive. In fact, it’s a million times too much as the joint and cells of the body are used to seeing a billionth of grams (nanograms).
What happens when you dramatically overdose tissues used to seeing nanograms of steroid with milligrams? Bad stuff!
- Traditional steroids are toxic to mesenchymal stem cells.
- Oral steroids markedly increase the risk of a serious bone disease—osteonecrosis.
- Steroid shots hurt tendon cells and make tendinitis symptoms worse.
- Repeated steroid shots break down cartilage.
- Steroids mess with the cortisol pituitary axis—your stress management hormones.
- Steroid epidurals increase the risk of fractures in older women.
- Steroids kill cartilage cells from arthritic joints.
Why, Then, Are We Still Injecting Patients with High-Dose Steroids?
Steroids are an inconvenient truth. They can make a patient feel better for a while, but they also likely cause more long-term harm than good. So why do we use them? First, many physicians don’t have anything better to offer. Let’s be honest here. In a world where regenerative-medicine solutions are exploding, that’s just a simple lack of imagination and knowledge on the part of the physician. Second, they’re covered by insurance, and many physicians have a hard time thinking outside of the insurance box, even if what’s in that box is not in the best interest of the patient.
How We Can Keep Our Insurance Overlords Happy and Help the Patient
When we first began using stem cells in 2005, the research was clear that nanogram-dose (ultra-low-dose) steroids was what the body was meant to experience. Meaning when you look at in vitro studies where cells are exposed to corticosteroids, the appropriate dose range to get an effect is in the tens- to hundreds-of-nanogram range. This is more than enough to activate receptors. In fact, steroids in this dose range can do some cool things, but steroids in the much higher milligram-dose range (one million times more) kill cells. Hence, the solution would seem to be simple: given the steroid injection risks, if you have to use steroids, why not just use them in the appropriate dose range for the body?
We’ve been using nanogram steroids for a decade now, and I can tell you that they work very similarly to their bigger milligram-dose cousin. You observe the same suppression of inflammation, and you’re not killing cells. In fact the only time I’ve seen them not work is in a patient with severe inflammation due to a systemic disease or in a patient whose body has gotten used to the sledgehammer effects of high-dose steroids.
The upshot? Ladies and gentleman, madams and monsieurs…it’s time to ditch the high-dose steroids! Just use the low dose version to protect your patients!