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Corticosteroid Injections

Local corticosteroid  (steroid) injections can often give rapid and effective reduction in pain and inflammation; however, as with all injection treatments relief will usually be temporary.  Although steroid injections are considered very safe, some people may experience side effects to treatment. Below we attempt to answer some frequently asked questions and provide you with some useful information before you consider making a booking for treatment. If you have any further questions please do not hesitate to contact us.

WHAT ARE CORTICOSTEROIDS AND HOW ARE THESE INJECTIONS USED?

Some corticosteroids are naturally occurring  in the human body and man-made (synthesised) steroids act like some natural steroids to reduce pain and inflammation. These are not the same as (anabolic) steroids used by bodybuilders to increase muscle size. Steroids can be taken as tablets or given as an injection. The rationale for injecting steroids is to target a much smaller dose more precisely to the area of pain.

 

Steroids are often used by people with inflammatory conditions and musculoskeletal pain, such as inflammatory arthritis and will be prescribed by a doctor or non medical prescriber. However, they can also be used in degenerative diseases such as osteoarthritis and a range of other soft tissue conditions which also involved pain and/or inflammation.

 

Different steroids exist, some are shorter acting which work very quickly but unfortunately they only give only very short lived relief for a few days. Longer acting steroids such as those used for injections take around a week to work but can last for several months after treatment.

 

WHAT HAPPENS WHEN I HAVE A ULTRASOUND GUIDED STEROID INJECTION?

You would have already had your diagnosis via ultrasound scan and would have chosen to have a steroid injection and had a prescription signed off by Physio Motive's non medical prescriber. 

Bradie will choose the most appropriate steroid and dose to use based upon your clinical condition and symptoms that is inline with medical guidlines. Provided there is no reason not to proceed he will then usually inject the steroid directly into the area that is inflamed, such into the joint or around the soft tissue identified in the diagnosis. Most injections are comfortable and well tolerated by the patient.

 

For safety reasons your clinician may need to postpone your injection e.g. if you have unstable blood pressure or if your blood sugars are known to be unstable due to diabetes. In these situations we may require specific written consent from your GP in order to proceed.

 

WHAT WILL HAPPEN AFTER THE INJECTION?

Often, if you have local anaesthetic, your pain may feel be relieved immediately after the injection. This initial numbing of the pain will usually wear off after a couple of hours. It will usually takes several days before the full effect of the steroid can be felt, with pain significantly reduced typically within a week of the injection.

 

You may wish to consider arrangements for your journey home after your injection. If you are planning to have local anaesthetic, this may cause some localised numbness for a couple of hours and therefore we recommend often best to avoid driving.

 

If you are having an injection into a joint you will be advised to avoid strenuous exercise for at around two days afterwards. If you are having an injection around a tendon, you may be advised to avoid heavy impact and strenuous loading activities for 10-14 days afterwards. Bradie will discuss return to activity and activity with you on the day of the treatment.

 

WILL I NEED FURTHER REPEAT INJECTIONS?

If you find the injection helpful with your pain, and other treatments have been unhelpful or are unsuitable, steroid injections can usually be safely repeated. Some injections are used in order to provide a ‘window of opportunity’ to engage in exercise and rehabilitation. Generally your pain is better controlled the focus will return to exercise and conservative management, therefore often the need for further injections can be reduced. You can discuss the possibility of repeat injections with your clinician on the day of the treatment.

 

WHAT ARE THE POSSIBLE RISKS AND SIDE EFFECTS?

The vast majority of people have steroid injections without any significant side effect.

 

Generally the risk of side effects is thought greater with stronger doses. The benefit of having ultrasound guided injections of steroid to give pain relief is to reduce the overall dose required in treatment. The steroids used are  and long acting steroids, such as Triamcinolone acetonide and Methoprednisolone. They are stronger and also dissolve less quickly in your body. These steroids are preferred in clinical practice as they give better pain relief and offer longer treatment affects.

 

WILL THE INJECTION HURT?

We use local anaesthetic for vast majority of our injections. There can still be some minor discomfort at the time of injection, but most people tolerate the treatment very well, and often report that the procedure was far less painful than they had feared. Ultrasound guidance allows many injections to be performed in a way that much more comfortable for patients.

 

WILL THERE BE POST INJECTION PAIN ?

Around a quarter (1 in 4) people may notice an increase in their pain (post injection flare) within the first 24-hours after injection. This usually settles within a couple of days. Simple painkillers, such as paracetamol and applying a cold compress, may help. Occasionally, post injection flare might be more pronounced and go on for up to a week. Very rarely, the pain can be severe (otherwise known as pseudo sepsis) and on these rare occasions, the patient must seek urgent medical attention.

 

CAN INJECTIONS CAUSE CHANGES TO THE SKIN ?

Some injections can occasionally cause some local thinning and lightening (depigmentation) in colour of the skin at the injection site. Rarely a steroid injection into muscles or joints can cause an small indentation (local fat atrophy) in the skin around the area. These changes will usually resolve after a few months and the area returns to normal.

 

ARE THERE RISKS OF INFECTION ?

Infection is a rare but potentially serious side effect following steroid injection. Studies suggest approximately 1:50,000, risk of infection following an injection.  We take every step to minimise these risks by ensuring all infection prevention and control guidelines are strictly adhered to at all times. If after the injection the area were to become more painful, swollen and hot, you are advised to seek medical attention immediately, especially if you are also feeling generally unwell.

 

 

WILL STEROID INJECTION MAKE ME GAIN WEIGHT ?

One of the main advantages of steroid injections , compared with taking in oral steroids (i.e. tablet form), is that the overall dose required for treatment will be much lower. This means that generally the chances of any systemic side effects are very rare.

 

WILL THE INJECTION AFFECT MY DIABETES ?

People with type I or II diabetes may experience a temporary fluctuation in their blood sugars. Therefore we recommend that patients who have been diagnosed with diabetes should always discuss with their GP before booking for a steroid injection.  If it is agreed by your GP that you can proceed with the steroid injection, it is important that you are extra vigilant of your blood sugars for around two weeks after the injection. If you feel unwell or are worried after the injection, you should speak to your doctor.

 

OTHER POSSIBLE SIDE EFFECTS ?

There are a number of other more minor side effects include facial flushing, temporary changes in menstruation and mood.

 

CAN I TAKE OTHER MEDICATIONS ALONG WITH THE STEROID INJECTION ?

You can take most other pain medicines along with having a local steroid injection. However, treatment for certain conditions such as diabetes, cancer or HIV usually will require you or your treating clinician, to first check with your GP or treating consultant. If you are taking a blood thinning medications (also called anti-coagulants) such as Warfarin, you will usually require a blood test (INR) to make sure that your blood is not too thin to have the injection. This is because of the increase risk of bleeding into the joint which can raise the risks of complications from the injection.

 

ARE INJECTIONS SAFE DURING PREGNANCY AND BREASTFEEDING ?

Unfortunately, we are not able to offer steroid injections to patients who are pregnant as the potential risks to the unborn baby are unknown . If you are currently breastfeeding , please discuss with  your therapist  – a leaflet produced by Breast Feeding Network in 2014,  has been produced to give you guidance in this area. Most injections will be safe as the doses used are usually within the recommended safe range.

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