Do the benefits of a cortisone injection outweigh the risks?

October 26, 2009 5:06 AM

I was diagnosed with Psoriatic Arthritis a year ago. I am on Enbrel and it has helped a great deal with the pain I experienced in my arms and joints but I am still having really bad pain upon walking or standing in my low back, sacral joint areas...I swim and do a variety of stretches but it is not allowing me the recovery I long for. I use to walk a few miles everyday, hike on the weekends and I haven't been able to do that in a couple of years. I miss it! I have been reading up on Epidural Cortisone injections and I am curious about personal results people have had. I am interested in the good as well as the bad stories, so I can decide, after meeting with my Doctors, if I want to go through with it. In other words if the benefits outweigh the risks.
posted by gypseefire to Health & Fitness (8 answers total)

A close family member has had rheumatoid arthritis for 35 years and is, like you, on Enbrel now, though she's seen everything from gold shots on. Her advice has always been twofold: first, when she has had very bad pain, she has gone on steroids temporarily. But: she has also seen people go on them too readily and stay on them indefinitely, and they seem to experience so many health problems as side effects of the steroids that she thinks it would have been better for them to avoid the steroids and push through the pain. Just to put it in perspective, she's gone on steroids maybe 4 times, for about a month at a time, in 35 years. She's in great shape, walking without assistance, swimming several times a week, climbing stairs, caring for her grandchildren.
posted by palliser at 6:24 AM on October 26, 2009

While not arthritic, I've had two epidural cortisone shots with different targets, both lumbar/sacral. While the injections were perfectly placed, neither one helped. We discovered later that the impingement was bone spurs and scar tissue, neither of which is affected at all by anti-inflammatory drugs.

The only side effect I had was a temporary (3-4 day) increase in pain and numbness, as the added fluid volume in the spinal column compressed the nerves further. While I won't make a decision for you, I will say that unless you have reason to believe that you will have an adverse reaction to the substances actually injected (a surface anesthetic, a contrast agent, then the cortisone/lidocaine), the benefits almost certainly outweigh the risks.

Really, I think the worst risk you run is that it won't work. (The chances of air bubbles or dura matter punctures are quite low if you have a good doc do the work.) As my doc said "it's highly unlikely that this will harm you permanently, and likely that it will help." (We were trying to avoid surgery.)
posted by jlkr at 6:40 AM on October 26, 2009 [1 favorite]

I know these shots have helped some people, but I tried it once and never would again: the ordeal of laying face down for an extended period, combined with the tension and the shot itself exacerbated my pain a great deal. Not only did the shot not help, I felt terribly worse for several days afterward (I wonder if that wasn't due to the extra fluid, like jlkr said).
posted by Eicats at 7:36 AM on October 26, 2009

I strongly recommend a class of Iyengar yoga. Iyengar yoga has helped a number of people with joint pain. Iyengar yoga is focused on alignment and strengthening muscles, and may provide considerable relief for your pain. Of course, yoga is not a short term solution, but I have had considerable success in relieving joint pain through yoga.
posted by satori_movement at 8:01 AM on October 26, 2009

I have psoriasis and pain from sitting at a computer 9-10 hours a day. I have found Bikram Yoga very helpful.
posted by charlesv at 8:38 AM on October 26, 2009

My mother is on Enbrel but has yet to take any additional injections for pain. Anecdotally, she does swear by concentrated black cherry juice for some pain relief.
posted by ktrey at 9:40 AM on October 26, 2009

I've had psoriatic arthritis for about 20 years and I've been on Enbrel off and on (mostly on) for 5 years. I know that this sounds weird, but my psoriatic arthritis jumps around. When I first had it it was mainly in the ball of my foot, then I had trouble with my ankles. In the past I've also had problems with my thumbs, and even a joint in my ribcage. Now non of the above bother me and it is mainly in my left knee, left big toe, and fairly recently, my lower back.

When my rhematologist heard about the breakthrough lower back pain, she immediatley switched me to humira. I still had quite a bit of enbrel left since I had just gotten a shipment so although I have the humira, I won't be starting on it for another week or two. If you mefi mail me, I can try to remember to email you when I start and see if I notice any dramatic differences between humira and enbrel.

I would also nth yoga, particularly iyengar or anasura, which are both all about proper alignment and not hurting yourself. I've also gotten some additional pain relief with high doses of fish oil, which my rhematologist not only approves of, but also suggested to me.
posted by kaybdc at 11:39 AM on October 26, 2009 [1 favorite]

Response by poster: I have that jumping around issue as well. It is a strange condition. I would love to know about the humira.
posted by gypseefire at 11:59 AM on October 26, 2009