When steroid shots are a good idea — and when they’re not

Steroid shots are a common occurrence in most doctor’s offices. After all, they may seem like a cure-all for what ails you… especially aches and pains in your joints due to inflammation.

There’s no denying there are many instances where they’re beneficial. But they are a temporary fix. So, if you find yourself talking to your doctor about yet another shot to ease the pain, it might be time to consider another option.

So, let’s talk about when steroid shots are needed and when to steer clear of them — and I’ll share again the value of PRP joint injections as an alternative…

Conditions treated well with a steroid shot

1. Anaphylactic allergic reaction: A Solumedrol shot is the initial drug of choice, often paired with Epinephrine (i.e. EpiPen) and Benadryl shots for hives with tightness in the chest/shortness of breath due to acute allergic reactions. These are life-savers.
2. Asthma: when you simply cannot breathe, and your Albuterol inhaler is not working — to the point where you can’t even sleep — you need a steroid shot. This shot should contain Solumedrol. It is not very painful going in but aches for ~25 minutes afterwards. One lady moaned and groaned for 25 min, while most can tolerate it just fine. Solumedrol begins working in a quickly as 30 minutes, peaks in 12 hours, and lasts 2-3 days. This is why I always recommend a short course of Prednisone beginning the next day, as this takes 2 days to get working.
3. Alopecia areata: This patchy hair loss (bald spots) responds well to small injections of Kenalog (triamcinolone acetonide) or Depo Medrol (methylprednisolone) into the scalp area of baldness. In this condition, your immune system attacks the hair-producing cells and causes inflammation at the root of the hair. This treatment is intended to block the local inflammation and allow for hair regrowth. These intralesional injections likely will need to be repeated about every four to six weeks until hair is growing back. They are simple to perform.
4. Severe allergic rhinitis: My former neighbor simply would not be able to breathe at night for weeks at a time during pollen season. Antihistamines, Flonase spray, and Cromolyn Sodium simply did nothing for him. He required an intramuscular (IM) shot of 40 mg Kenalog, and in 3 days he became nearly symptom-free for a month or longer, typically enough to get him through the season.
5. Large cystic acne lesions: Cystic acne lesions are more painful and harder to treat than other large pimples that come to the skin surface. If treated within the first 24 hours of onset, a cystic acne lesion will shrink quickly with a shot of Kenalog.
6. Plantar fasciitis: The plantar feet become painful when the meshwork of ligaments there (fascia) becomes inflamed. The first treatment is to stay off your feet completely, do gentle massage, and stretching. However, when this condition gets so painful despite your best efforts, small injections of Kenalog does the trick. I have don’t several of these in the Urgent Care setting with great results. The injections are tolerable if done using a tiny 30-gauge needle immediately following a 3-second spray at each injection site using ethyl chloride.
7. Shoulder bursa: When shoulder pain persists after adequate rest and immobilization, one steroid shot to the subacromial or joint space usually does the trick for many years to come. If not, read about PRP below.
8. Trigger finger: When a finger or thumb joint becomes stuck in flexion position, the tendon inflammation through the sheath gets locked up, like a knot in the rope of a pulley. The treatment that nearly always works before considering surgery is a small amount (10 mg, or 0.25 ml) of Kenalog injected directly into this joint area.
9. Scar reduction: A Kenalog (triamcinolone acetonide) shot into a raised scar (keloid) will shrink it down if the shots are repeated over several months. It reduces its size, tightness, and itchiness and the scar color fades naturally within a couple of years.
10. Ganglion cyst: This is an accumulation of synovial fluid into a pouch at a joint area from overuse. The wrist is the most common joint to cause this. It will eventually go away spontaneously, but it may take six to 24 months to do so. Using a large bore (18 gauge) needle the thick clear fluid can be aspirated out and steroid placed in to shrink it.

When to be wary of steroid shots

Pain and swelling are that initial phase of inflammation — your body’s natural way of protecting and healing. For example, your ankle swells up after injury and the pain forces you to protect and rest it. After 3-5 days, the next phase of inflammation sets in to dissipate that initial fluid swelling. Therefore, you want to suppress the inflammation during the first several days and encourage the healing phase of inflammation thereafter, while preventing injury.

Now consider chronic non-healing joints such as the shoulder, elbow or knee. They can be injected with steroid to suppress the inflammation. However, they do not encourage the regeneration of tissue. That’s why if you are not healed after one injection, I would steer you away from more, and towards PRP (platelet-rich plasma) injections instead.

Related: The joint regenerative power of stem cell therapy

PRP has been used widely over the last decade, especially in the field of orthopedics. PRP is autologous blood that, per this FDA definition, is collected from a patient, centrifuged, and contains at least 250,000 platelets per microliter. FDA clearance allows PRP to be used for a wide range of different orthopedic indications.

Platelet Rich Plasma (PRP) from your own blood contains growth factors. Adding your own (PRP) to damaged tissue is like adding fertilizer to the seeds and plants already existing in your body. PRP has also long been well proven to be effective in joint regeneration.

If your symptoms have lasted more than a few months, here are some conditions you should consider getting treated with PRP:

• Shoulder tendonitis/tendinopathy or torn shoulder ligaments (rotator cuff)
• Tennis elbow
• Wrist or thumb tenosynovitis/trigger finger
• Plantar fasciitis or Achilles tendonitis
• Knee tendonitis, torn knee ligaments (cruciate, meniscus)
• Patellar tendonitis
• Degenerative arthritis of the shoulder, back, hip, knee, ankle, or foot
• Scars
• Androgenic alopecia in men and women (but not effective for alopecia areata)

Editor’s note: If you suffer from chronic pain and conventional medicine has let you down, or you just want to escape the potential dangers of OTC and prescription drugs even for occasional pain, you must read Conquering the Pain: An Alternative Doctor’s Fresh Look at the Newest and Oldest in Alternative Pain Therapies. Click here for a preview!

To healing and feeling good,

Michael Cutler, M.D.

Sources:

1. The Economics and Regulation of PRP in the Evolving Field of Orthopedic Biologics — Current Reviews in Musculoskeletal Medicine
2. PRP and Stem Cells | Patient Information — Colorado Sports Doctor