A few years ago we reported on an FDA warning about neurological problems after epidural corticosteroid injections. But what is the newest information? A lot of people are in pain, and because of that, many procedures are done to manage that pain. And the number of those pain management procedures are increasing over the years.
A variety of painful conditions benefit from techniques that reduce pain. And corticosteroid injections or cortisone injections are a common treatment recommended by many physicians. At OrthoRegen, we treat joint pain with Regenerative Orthopedics, which also are injections, but they do not contain cortisone.
Corticosteroid injections are given in different locations. They may be injected into joints, or they may be used as nerve blocks. Injectable corticosteroids are used quite often to reduce swelling or inflammation. And corticosteroids injected into the epidural space of the spine have been performed for many decades.1 But in our previous article, we discussed the FDA warning that injections of corticosteroids into the epidural space of the spine can result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.
Corticosteroids are also injected into the neck along with some type of anesthetic for a procedure called a stellate ganglion nerve block (SGNB). These procedures have been around for quite a while too. Are they safe? We took a look at the results from a systematic review in the journal, Regional Anesthesia & Pain Medicine. What’s a systematic review? These types of reviews gather a bunch of different studies and take a look at the overall results of all of those studies.
The research team in this particular systematic review looked at eighteen years of results and 4812 studies. The researchers identified 260 cases of adverse events with SGNB, including medication side effects, a patient who developed quadriplegia, five who required a tracheostomy, and one death.
What was the most common side effect? Hoarseness was reported in 27.6% of the cases. This particular type of nerve block is considered relatively safe, with severe complications occurring in 1.7 out of 1000 blocks. Interestingly, complications also occurred in a delayed manner, leading the researchers to conclude, “The importance of constant vigilance along with accessibility to resuscitation equipment for all SGNB procedures cannot be overstated.”2
Serious adverse events include death, paralysis, seizure, stroke, and others that can occur after corticosteroid injections in both epidural and SGNB procedures. Because of this, we recommend seeking more conservative therapies to treat pain first. Regenerative Orthopedics is one way to treat joint pain without the need for surgery. These non-surgical techniques are effective at treating many painful joint conditions.
What are some examples of corticosteroids? Injectable corticosteroids include methylprednisolone, hydrocortisone, triamcinolone, betamethasone, and dexamethasone.
There are times that corticosteroids are needed. But there are ways to avoid them and their side effects when they really are not necessary. Regenerative Orthopedics is a great way to avoid cortisone injections to treat and repair painful joint conditions.
2 Goel, Vasudha, et al. “Complications associated with stellate ganglion nerve block: a systematic review.” Regional Anesthesia & Pain Medicine 44.6 (2019): 669-678.