Steroidal Anti-Inflammatory Drugs

Many patients with back pain are prescribed with medications to reduce inflammation in injured tissues of the body that have become damages. These medications typically fall under one of two categories:
  • Non-steroidal anti-inflammatory drugs: these drugs are typically consumed orally or topically through the use of certain skin creams.
  • Steroidal Anti-Inflammatory Drugs - otherwise known as steroids.
Steroids are typically prescribed or administered by doctors when other more conservative treatments have failed; including Non-steroidal anti-inflammatory drugs (NSAIDs). These medications, though non-habit forming (non-narcotic) has a higher risk of medical complications, and are thus prescribed only when necessary. That being said, they may provide patients with significant pain relief that they wouldn't have under any other type of treatment.

Oral steroids: Oral steroids are powerful anti-inflammatories that may effectively treat low back pain and other musculoskeletal disorders. These medications are only intended to be used in small windows of time, like the equally powerful narcotic agents (e.g. hydrocodone, oxycodone, Percocet). Typically, these medications are prescribed to be taken for a period of one to two weeks. Doctors may differ in the dose schedule they recommend for their patients to take. Typically, many doctors order a Medrol dose pack in which patients begin a high dose to treat their acute lower back pain, followed by a gradual decreasing dose until the patient has finished their prescription.

These medications are very powerful, and patients should take care not to take a bigger dose at a time that is listed on the bottle or from their doctor. That being said, these medications are associated with a minimal complication rate as long as they are only taken for a short period of time (2 weeks or less). The complication rate increases significantly the longer they continue to be taken. Some complications associated with long-term use of steroids include collapse of the hip joint, osteoporosis, stomach ulcers, weight gain, as well as other problems.

People with other medical conditions, such as diabetes, should be wary of taking oral steroids. Since these medications increase blood sugar, diabetics and people with other metabolic disorders should consider not taking them due to these risks. Patient's with an active infection in their system (e.g. urinary tract infection, sinus).

What are steroids? How do steroids work, and what are some of the differences between these types of medications and others that treat inflammation and associated pain? Steroids are also known as corticosteroids or glucocorticoids. These drugs decrease swelling or inflammation by binding to glucocorticoid receptors. A steroid is a compound that is composed of four cycloalkane rings that are all bonded with one another. These four rings, depending on their configuration, may influence hormone levels and certain inflammatory processes in the body. The pharmaceutical drug - dexamethasone - is one of the most common anti-inflammatory steroids.

Dexamethasone: Dexamethasone works in the human body by acting as an immunosuppressant and anti-inflammatory. This synthetic medication is over 25 times as powerful as the similar hormone cortisol, which exists naturally in the human body. This drug may be used with patients with autoimmune disorders such as rheumatoid arthritis and ankylosing spondylitis. Dexamethasone may be taken as tablets, or it may be injected directly into the epidural space of the spine or areas of the body which are swollen and painful. Let's take a look at the procedures that are used by doctors for delivering these types of medications through injections.

Epidural steroid injection: An epidural steroid injection is a procedure by which a doctor himself or herself injects a small amount of steroid into the epidural space of the spine. This procedure involves the injection of steroid material via needle, guided carefully into the correct area using radiologic guidance such as X-Ray or Flouroscopy. Once the steroid substance has reached its target, the medication is supposed to have the effect of blocking the transmission of pain signals from travelling up the spine, or reducing inflammation. These substances block or inhibit the inflammatory response in the body, or it may have the effect of flushing out inflammatory proteins from the affected areas.

Epidural steroid injections may be used to treat chronic back conditions such as lumbar spinal stenosis, degenerative disc disease, and lumbar disc herniation. These injections are listed under the category of minimally invasive surgery, though they do not involve hospital stays or recovery time. Typically, patients will leave the hospital or clinic shortly after their procedure, barring any unforeseen complications or side effects. Complications and risks that are associated with this procedure include dural puncture, nerve damage, and infection.

The substance that is delivered from the needle involves the steroid as well as saline, which are designed to have the effect of flushing out inflammatory proteins from the spine or affected tissues. The epidural space encloses the dural sac and is filled with blood vessels and fat. The dural sac encloses the cerebrospinal fluid, nerve roots, and spinal cord.