Steroids for back pain: Function, types, side effects

Steroids, also known as corticosteroids, are man-made hormones that can help reduce swelling and inflammation in the body. Reducing the inflammation that may be causing back pain can help people improve their discomfort.

Back pain is not a specific diagnosis or disease but a symptom of other underlying conditions. Before prescribing medications, doctors need to address the cause of back pain to recommend the most appropriate treatment for the condition.

If a person experiences back pain that gets worse or that does not improve with rest, they should contact their doctor.

This article discusses how steroids can work to treat back pain, what conditions they can treat, and the types of steroids available. It also looks at possible side effects and how people can take them.

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Steroids are man-made hormones that are similar to the hormones that the adrenal glands in our bodies produce. Adrenal glands are two small glands positioned above the kidneys.

Steroids taken in a higher quantity compared to what our body typically produces can reduce swelling and inflammation in parts of the body, including the back. This may help reduce the discomfort that people with back pain may experience.

Steroids are available in different forms, including pills and injections.

Learn more about corticosteroids.

Steroids can help improve conditions that involve the inflammation of the spinal nerves. These may include:

• sciatica
• spinal stenosis
• degenerative disc disease
• herniated disc
• spondylolisthesis
• compression fractures
• spondylolysis
• scoliosis

Learn more about causes of back pain.

Steroids can be effective for back pain. Corticosteroids can help reduce the nerve inflammation of spinal nerves that may be at the origin of the discomfort.

However, in certain cases, depending on the condition causing the back pain and its severity, corticosteroids may not be sufficient to treat back pain. In the most severe cases, people may need to undergo surgery.

Learn about more treatments for back pain.

Corticosteroid tablets taken for less than 3 weeks usually do not have side effects.

However, a person receiving a steroid injection or taking steroid tablets for a prolonged period of time may experience side effects.

Possible side effects may include:

• heartburn or indigestion
• high blood pressure
• increased appetite and related weight gain
• increased risk for infections
• sleeping difficulties
• increased blood sugar levels in people with diabetes
• weakening of the bones (osteoporosis)
• increased risk of bruising on the skin
• development of eye conditions, such as cataracts and glaucoma
• feeling anxious or irritable
• depression or suicidal thoughts

Steroid injections may cause:

• bruising and discomfort at the injection site
• flushing or redness in the face for a few hours
• changes in the color of the skin near the injection site, which may be permanent
• swelling
• raised blood pressure for a few days if a person has high blood pressure
• increased blood sugar levels in people with diabetes
• development of infections

People can take corticosteroids in different forms. This includes taking steroids orally in the form of pills and tablets, or they can be administered via injections. The length of the corticosteroid treatment may vary depending on the severity of people’s condition and symptoms.

People should take oral pills and tablets soon after a meal as this may help reduce the risk of stomach irritation and related side effects.

Oral pill strength may vary from 1–25 milligrams (mg). Doctors typically recommend taking the prescription in one single dosage once a day. The prescription may vary from 5–60 mg a day. However, in certain cases, the dosage prescribed may be higher.

Doctors recommend avoiding receiving more than 3 injections of steroids in the same area of the body in a period of 12 months and to wait for at least 6 weeks between injections.

People should always follow their doctor’s recommendations when taking steroids.

Here are some more frequently asked questions about steroids and back pain.

Will steroids help with back pain?

Steroids may help reduce back pain. This may depend on the cause and severity of the back pain.

What kind of steroids are used for back pain?

The steroids used for back pain come in the form of injections and oral tablets. Injections can include intravenous (in the vein) or intramuscular (in the muscle) steroids.

How quickly does prednisone work for back pain?

How quickly prednisone takes to work for back pain may vary depending also on the cause of the back pain and other underlying factors. It typically works very quickly, within around 1–4 days.

What is the best steroid for pain?

Prednisone is one of the most common steroids prescribed for treating a wide range of conditions.

However, this medication may not be suitable for everyone. Doctors can recommend the most effective treatment based on the type of underlying condition at the origin of the pain.

Steroids can help reduce inflammation in the back and improve back pain. These medications come in the form of pills and injections.

Prednisolone is a common type of oral steroid and doctors often prescribe it to treat chronic back pain. Prednisolone may take a few days before it starts improving back pain.

The type of medication and the length of the treatment a person’s doctor recommends may vary depending on what’s causing the back pain.

People with back pain can contact their doctor to discuss what could be the most appropriate treatment for their condition.

Oral Steroids and Back Pain

Corticosteroids can be administered in numerous ways, though injection and oral forms are the two most commonly used for spine pain. Photo Source: 123RF.com.

Oral steroids, or corticosteroids taken by mouth, are prescription anti-inflammatory medications that have been commonly prescribed for various orthopedic conditions, including low back and neck pain. While these drugs can reduce pain and inflammation, they also have potential serious side effects that you should discuss with your doctor.

Corticosteroids can be administered in numerous ways, though injection and oral forms are the two most commonly used for spine pain. Here are some basics on oral steroids, which come in tablets, capsules, or syrups.

How Oral Steroids Work

Oral steroids are designed to work in the same way as the hormones produced by your adrenal glands in response to stress and injury. When the corticosteroids you take raise your body’s natural adrenal hormones above their normal levels, this reduces inflammation.

Corticosteroids also suppress your immune system, which helps people who suffer from autoimmune conditions (such as rheumatoid arthritis) but can also decrease your ability to fight infection.

Oral Steroids: General Dosing Information

Below are examples of oral steroids (generic names are listed first, and a brand name example is in parentheses):

• Methylprednisolone (Medrol)

• Prednisone (Deltasone)

• Dexamethasone (Decadron)

Oral steroids are generally prescribed for a limited time—typically one or two weeks. In most cases, you will take your strongest dose on the first day of therapy and taper down until you do not have any medication left.

Example of a Methylprednislone (Medrol) dose pack (Sandoz, Novartis). Image courtesy of https://en.wikipedia.org/wiki/Methylprednisolone.

For example: You might take seven oral steroid pills on day 1, six pills on day 2, and so on until you reach one pill a day. Then, at the end of the week (or second week), you take no more medication.

Oral steroids are prescribed in shorter doses because of their strength and potential side effects.

Who Should Take Oral Steroids?

With a shorter course of therapy, these medications may help ease painful inflammation associated with severe acute back and neck pain (pain that arises and resolves quickly, though it may last up to three to six months).

Oral steroids may also help with painful flare-ups common with chronic inflammatory diseases, such as rheumatoid arthritis. Common conditions treated with oral steroids include low back pain and herniated discs.

Oral Steroid Strengths and Weaknesses

Among the biggest benefits of oral steroids is that they offer relief from pain and inflammation without the invasiveness of their injected counterparts. Unlike spinal injections, oral steroids do not require MRI or radiation exposure, and may pose less of a risk for some patients. Spinal injections, however, deliver a more concentrated dose of corticosteroids with a lower degree of systemic (whole body) side effects.

Oral steroids do have some drawbacks, though. Compared to steroid injections, it takes longer for oral forms to take effect. Oral steroids also impact your entire body—not a single area like an injected form. Because of this, oral steroids carry more significant side effects than other delivery methods.

Possible side effects may include:

• Weight gain

• Elevated blood pressure

• Increased eye pressure (glaucoma)

• Swollen legs

• Psychological changes, such as mood swings, memory loss, and behavioral changes

• Sleep difficulties

It is a long-held belief that short-term use of oral steroids provides protection against more serious side effects. However, a recent study published in April 2017 in the BMJ found that adults using oral steroids had a two-fold increased risk of fractures, a three-fold increased risk for venous thromboembolism, and a five-fold increased risk of sepsis within 30 days of starting the medication. The study authors recommend using the lowest dose of oral steroid possible to reduce the potential for these complications.

In addition, there are no well-designed studies that have supported the effectiveness of oral steroid medications for neck and low back pain.

If oral steroids are required as a long-term treatment—such as in treatment of certain inflammatory disorders like lupus or ankylosing spondylitis—you should be aware of the following side effects that may occur with prolonged use:

• Slower wound healing and increased skin bruising

• Increased infection risk

• Clouding or blurred vision

• High blood sugar

• Osteoporosis and fractures

• Avascular necrosis of bone (death of bone due to lack of blood supply)

Safely Using Oral Steroids for Spine Pain

Oral steroids are prescription-only medications. During your visit with your doctor, ask about the side effects and complications associated with these drugs. Also, make sure you understand exactly how to properly use your oral steroid, as it may be on a tapered schedule in contrast to a simple one-pill-per-day regimen.

Safely using your drug means using it exactly as your doctor prescribes. If you have questions about how to use your oral steroid, call your doctor or speak to your pharmacist when you pick up your prescription.

Oral steroids can be an adjunct to reduce pain and inflammation from back or neck pain (particularly from a pinched nerve) when other treatments have failed, but it is essential to use them as your doctor orders to prevent potentially harmful side effects. If you complete your course of medication and find that, your pain is still interfering with your quality of life, talk to your doctor about other treatments (such as physical therapy, spinal injections, etc.) that you may explore.

Notes: This article was originally published August 22, 2017 and most recently updated April 12, 2019.

• Prednisone and other corticosteroids. Mayo Clinic Web site. http://www.mayoclinic.org/steroids/art-20045692. Published November 15, 2015. Accessed April 12, 2019.
• Swift D. Even Short-term Oral Steroids Carry Serious Risk. Medscape. http://www.medscape.com/viewarticle/878850. Published April 20, 2017. Accessed April 12, 2019.
• Waknine Y. Oral Steroids Have Little Effect in Patients With Sciatica. Medscape. http://www.medscape.com/viewarticle/845050. Published May 20, 2015. Accessed April 12, 2019.

Our Review Process

Prednisolone – what you need to know about taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many people think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisolone that is considered an obligatory and necessary drug of first choice in the treatment of a disease (for example, nephrotic syndrome, which you can read about here).

We are not talking about the drug itself and for what diseases it should be prescribed, but our information block about what doctors usually forget when they prescribe prednisolone. Usually, children come for a consultation while taking prednisolone in combination with asparkam. Believe me, hypokalemia (decrease in the level of potassium in the blood), in connection with which asparks are prescribed, is not the most common complication when prescribing prednisolone.

In our practice, almost 90% of patients receiving this drug are diagnosed with nephrotic syndrome.

Prednisolone is prescribed for a long period of time (the full course of therapy before the drug is discontinued may last 6-12 months), additional drugs must be prescribed to prevent the side effects of prednisolone. They are:

1. In order to protect the mucosa of the upper gastrointestinal tract (esophagus, stomach, duodenum), prednisolone may cause indigestion, nausea, vomiting and more serious complications such as steroid ulcers. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e. Protection of the stomach in literal translation). These are antacids (eg Maalox, phosphalugel, etc.), H+ pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone thinning) can develop, which ultimately leads to bone fractures. But this condition can also be prevented, it is necessary to take calcium and vitamin D preparations . The dose of drugs is also selected individually.

Other things to watch out for:

1. Mandatory blood pressure monitoring
2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.
3. When taking prednisolone for a very long time, check blood glucose levels.
4. State of mental health. Children very often become capricious, sometimes even aggressive. This condition resolves on its own after discontinuation of the drug.
5. Watch your weight and diet. Against the background of taking prednisolone, the appetite increases very much. However, you, as a parent, can control the nutrition of your child, it is necessary to limit the intake of easily digestible carbohydrates.
6. In order to monitor and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by – EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes only. It is necessary to consult with your doctor.

If you have any questions or suggestions about this topic, we are happy to answer questions and accept your suggestions.

Therapeutic and diagnostic blockade for pain in the back and joints: indications, methodology

Author of the article

Date of article update: 07/12/2023

In recent decades, one of the most effective ways to relieve pain in various degenerative diseases of the spine is a therapeutic blockade. The meaning of the blockade is to deliver a strong anti-inflammatory drug to the site of inflammation, thus, it is often possible to significantly reduce the intensity of pain or stop it completely in various diseases and syndromes. For example, to eliminate pain in the lower back during exacerbation of spondyloarthrosis or sacroiliitis, to reduce the intensity of pain in the leg or arm in various radiculopathies (with protrusion and hernia of the disc, various other stenoses of the spinal canal). But, if the prescribed drug therapy does not raise questions in patients, then the fact of receiving an injection, also in the focus of pain, becomes, for the majority, a frightening prospect.

Does it make sense to be afraid of a blockade and is it really that effective?

Therapeutic-diagnostic blockade is a drug injection (injection) that is made directly into the center of inflammation, thus, in the shortest possible time, it relieves pain. To achieve an accurate hit in the focus of inflammation allows the blockade under ultrasound or X-ray control in a specially equipped operating room. X-ray, ultrasonic sensor allow you to control the position of the inserted needle in accordance with anatomical landmarks throughout the procedure. Depending on the localization of pain and its causes, in a strictly individual order, the administered drug / group, its dosage and frequency of administration are selected.

The main purpose of the blockade is to stop inflammation. The second, but important purpose of the blockade is a diagnostic search for the source of pain, which is why the blockade is called diagnostic and treatment. Often, patients with diseases of the spine and musculoskeletal system have a whole list of pathological changes in the vertebrae, intervertebral discs and joints, ligaments, adjacent muscles, and large joints of the limbs. Each of these pathological foci can generate a pain impulse, the inflammatory process can involve nearby nerve structures. Pain signals from several foci can “overlap” and “mask” or “potentiate” and reinforce each other. To determine the source of pain, establish the correct diagnosis and determine the optimal treatment tactics, they resort to conducting the so-called. selective (selective) blockades. Having brought the pain medication to the probable source of the patient’s suffering, and evaluating the result, we can draw the appropriate conclusions: the blockade did not help – the source of pain is hidden in another place, it is necessary to continue the diagnostic search; the blockade helped – the source of the pain was found, if the pain occurs again, it is necessary to discuss options for its elimination (surgical treatment, revision of conservative therapy, rehabilitation measures).

How does the blockade work and where is the drug injected?

Depending on the source of the pain impulse, the doctor determines the indications, the level and area of ​​administration of the drug, as well as its dosage.

With indications, appropriate equipment and skill, the drug can be applied to almost any anatomical structure of the body. The following blockades are most often performed:

1. Blockade of the intervertebral joints – the drug is injected under the control of fluoroscopy directly into the cavity of the facet (facet) joints – these small joints bind the vertebrae together into one rigid, but movable chain (vertebral column). Their inflammation (spondyloarthrosis) is the most common cause of low back pain.
2. Epidural blockade – the drug is injected into the cavity of the spinal canal under the arch of the vertebra, in the space between the ligament that covers the sheath of the spinal cord roots and the sheath itself, under x-ray control. Indications are radicular (radicular) symptoms of various origins: in the presence of a herniated disc, degenerative stenosis (narrowing) of the spinal canal, inflammation after injury and surgery. The drug introduced into the canal spreads in loose fiber over the roots, stopping the inflammation and associated pain.
3. Foraminal blockade (blockade of the “outgoing” root) – the drug is injected, under X-ray control, not into the spinal canal, but into the area of ​​​​the opening (Latin – foramen) through which the nerve root extends beyond the spine. Indications for carrying out are similar to indications for epidural blockade.
4. Blockade of the sacroiliac joint – the drug is injected into a large joint, which is the junction of the sacrum and pelvic bones. Inflammation of the sacroiliac joint – sacroiliitis is the cause of pain in the sacrum, extending to the gluteal region, sometimes the pain is so intense that it does not allow a person to walk. It is carried out under x-ray control.
5. Various blockades of muscles (piriformis, scalenus, rotator cuff) and peripheral nerves (lateral femoral cutaneous nerve, pudendal nerve, etc.) are performed under ultrasound guidance and serve both therapeutic and diagnostic purposes. Carried out for various peripheral neuropathies, tunnel syndromes, consequences of injuries and operations
6. Blockade in spastic syndrome – the introduction of a substance based on botulinum toxin to eliminate excessive muscle tone – spasticity

Is blockade a cure?

In diseases of the spine, for example, protrusion of the disc with radicular syndrome or herniated disc, spondylarthrosis, degenerative stenosis, the blockade is not the main method of treatment, but is an “ambulance” to relieve pain, improve the quality of life, increase the patient’s mobility. It is noteworthy that after the blockade, the pain syndrome can go away for a very long time, possibly for years. With bursitis, periarthritis, non-infectious arthritis, that is, diseases associated with inflammation of the joints, blockade can be considered as a separate type of treatment, with the right combination of administered drugs.

What medicines are used for blockade?

The main active substance used in various types of blockades is a derivative of the group of glucocorticosteroid hormones, which has a powerful anti-inflammatory, desensitizing effect. Preparations of this group are divided depending on the duration of action:

1. Short-term action: cortisone, hydrocortisone (8-12 hours)
2. Intermediate duration: prednisolone, methylprednisolone, triamcinolone (24-36 hours)
3. Long acting: dexamethasone, betamethasone (36-54 hours)

In addition to corticosteroid hormones, the composition of the drug solution administered during the blockade includes local anesthetics, which effectively block the pain impulse that occurs in the nerve fiber. These include:

• Lidocaine (duration of action 0.75-2 hours)
• Mepivacaine (1-1.25 hours)
• Bupivacaine (2.5-6 hours)
• Ropivacaine (naropin) (2.5-5 hours)

This combination of drugs allows you to achieve an analgesic effect in the shortest possible time: the first few hours the local anesthetic acts blocking the pain impulse, at the end of its activity, the steroid hormone begins to act and acts for several days. It should be remembered that the introduction of these drugs should be performed only after the appointment and under the supervision of a physician! Local anesthetics with an incorrect dose or incorrectly administered have a toxic effect, can cause tissue necrosis, a sharp decrease in blood pressure, loss of consciousness, psychosis and hallucinations. Glucocorticosteroids have a whole range of adverse reactions and contraindications, including vascular crises, gastrointestinal bleeding, increased intraocular pressure, and systemic infection.

Are there any contraindications?

As with any treatment, blockade has a number of contraindications:

• allergic reactions,
• mental disorders,
• diseases of the cardiovascular system,
• hypotension,
• presence of infectious diseases,
• hemophilia and other bleeding disorders.

Which specialist should I contact?

Axis clinic specialists advise to carefully choose a doctor – a specialist, since serious complications, including infectious inflammations and anaphylactic shock, can occur with the wrong administration or selection of drugs. When contacting Axis patient:

• receives a consultation with a neurologist or neurosurgeon, during which an examination is carried out, a complete patient history is collected, the results of neuroimaging methods are evaluated to establish a diagnosis, the cause of pain and individual selection of a drug, in order to avoid possible complications and aggravate the condition
• blockade is carried out under conditions of complete sterility, usually in a sitting or lying position.