Joint Injections for Pain – Do Risks Outweigh Benefits?
Introduction to Joint Injections for Pain Relief
Steroid injections are becoming as common as advil these days to treat joint pain. Doctors offer steroid injections to people suffering with hip, shoulder, knee, back and other joint pain as a way to relieve pain. Some swear by it and some feel absolutely nothing afterwards.
Up until recently, these joint injections were thought to be low risk with nearly no side effects. However, a recent study from the medical journal, Radiology, calls into question the safety of injections for joint pain
Let’s take a closer look at this study on steroid injections and what it means for you. The study found four main negative effects from steroid injections, and we will address each of these below.
It is important to understand that the beginning of this article is going to summarize what the study found and NOT WHAT WE BELIEVE. The second portion of this article is going to give you OUR OPINION OF THIS STUDY, which is very different than the medical journal’s philosophy.
We believe that anyone with chronic pain should carefully consider this information before deciding to get injections for hip pain, shoulder pain, back pain, or knee pain.
Who am I?
I'm Maks Reznik. When I started to experience debilitating hip pain, doctors and physical therapists told me I needed surgery to fix my FAI.
I decided against it, and years later I'm happy I did.
You can see more of my story in this video.
How Researchers Studied Joint Injections for Pain
In this study, 459 individuals received hip or knee injections in the researchers’ clinic. At the time of injection, researchers took an MRI of the affected joint.
The study participants received 1 to 3 joint injections each with an average of 1.4 joint injections per participant. The participants returned for follow up within 2 to 15 months after their last joint injection. On average, follow-ups occurred seven months after the last joint injection.
When the patients returned for their follow-ups, researchers conducted an MRI to see if any change occurred to the affected joint. The study found that 36 out of the 459 patients (8%) experienced an adverse outcome in the affected joint.
Nurse Preparing Needle For Injection
The Findings on Injections for Joint Pain
The Four Adverse Effects from Joint Injections
The four adverse outcomes discovered in this study included the following:
- Accelerated osteoarthritis progression in 6% of patients;
- Subcrondral fractures in 0.9% of patients;
- Osteonecrosis in 0.7% of patients; and
- Joint destruction and bone loss in 0.7% of patients.
Now what do those mean in plain English?
Accelerated Osteoarthritis (“OA”) - this was by far the most concerning negative outcome. 6% of all patients receiving injections in the study experienced accelerated OA. The orthopedic community defines accelerated OA as a loss of joint space of more than 2 mm within 12 months.
Subchondral Insufficiency Fracture (“SIF”) - this outcome affected nearly 1% of all study participants. The study indicates that if SIF is not diagnosed at an early stage, it can progress to articular surface collapse. If there is a collapse, orthopedic surgeons would likely recommend joint replacement.
Do You Need a Medical Diagnosis to Get Out of Joint Pain?
At Upright Health, we believe that movement function is always more important than an arbitrary medical diagnosis. Other than the initial story clients tell us about their pain, their diagnosis, rarely if ever, comes up again during their training with us. In this article, we explain the medical diagnoses mentioned in the study because it gives you better insight on what the findings of the study tells us. However, if you received any of these diagnoses, we DO NOT think you are broken or incapable of getting out of pain. Improving movement function > Getting perfect medical diagnosis for joint pain.
Osteonecrosis - believed to be caused by reduced blood flow to the joints. The study indicates this lack of blood flow can cause bone plate collapse. The collapse can increase chances of developing OA and more pain. Orthopedists would likely recommend joint replacement.
Joint Destruction and Bone Loss - although this outcome occurred in less than 1% of patients, it’s the most scary. This was identified as rapid bone loss that is worse than OA.
Our Position on this Joint Injection Study
There are two primary reasons you might get a steroid injection for joint pain.
- The first is pain relief.
- The second is to test whether the cause of pain is in the joint itself.
Both of these reasons are dubious and we'll analyze each separately.
Steroid Injections are a Band-Aid Fix and May Cause Bigger Problems Down the Road
For pain relief, results are mixed. It is not surprising that some joint pain sufferers receive short-term relief because they are being injected with a powerful anti-inflammatory steroid. On the other hand, short-term relief can actually cause bigger problems down the road since it can impede the structural healing of the joint.
Let’s think about what happens if a movement compensation or muscle imbalance is causing your joint pain. The steroid injection numbs the area but does not resolve the underlying compensation. You will no longer get feedback from your brain that there is something wrong in that area of your body.
You resume your activities that used to cause you pain and may even turn on a higher gear. However, because you didn’t resolve the underlying dysfunction, the structural damage in the body continues to worsen. Once the numbing agent eventually wears off, it’s possible that the pain comes back worse than before.
Pain is There for a Reason!
The joint injection shuts off an important signal that our brains are receiving from the painful area. Pain is the first signal that something is amiss. By numbing this important signaling mechanism, we are telling the brain that action is not needed...even though it might be!
Now we have a study that spells out, in overloaded medical language, the type of structural damage that’s possible. OA, SIF, Osteonecrosis and bone loss? Based on the findings, the risk of ending up with any of these types of structural damage is slightly less than 9%.
That is pretty high for a pain treatment that provides short term relief at best. Maybe it makes more sense to focus on the underlying compensation that is causing the pain in the first place?
Steroid Injections are not a Reliable Test for Joint Damage
As for testing whether the pain is in the joint itself, this is just plain wrong. In the last few years, we’ve published numerous articles going over the shoddy science supporting intra-articular injections as a diagnostic tool for FAI and other joint issues (Check it out here, here and here).
For example, one study found that pain relief from a steroid injection does not show that surgery will work. Doctors often claim that if an injection works to relieve “joint pain,” the cause of your pain is inside the joint. This then provides justification for surgery to “fix” the joint.
Studies show this simply isn’t the case.
If your doctor gives you a cortisone shot and your hip pain goes away, it DOES NOT mean that surgery will be effective. Even though doctors continue to use this is a test for surgery, studies show that there is no connection between pain relief from a steroid injection and a successful surgery.
And let’s not forget that we now learn that around 9% of those receiving injections will develop some kind of joint damage.
Warning
9% of study participants receiving joint injections developed some kind of negative side effect.
So let’s put this all together. An injection for joint pain is not a reliable test to measure the effectiveness of surgery. And it can potentially make things much worse for the affected joint.
There are not many things that are definitive in the world of science, especially medicine. This gets pretty close though. Using steroid injections to determine whether the pain is coming from the joint itself is not supported by science.
Closing Thoughts
There is only one reason to receive a steroid injection for joint pain that makes a little sense: You are looking for the possibility of short-term pain relief without any concern for the long-term effects or a long-term solution.
If you decide to get injections at least know what you're getting!
If you're struggling with this decision, a good way to simplify it would be to zoom out and look at the big picture. Steroid injections are not a long term solution and they do have side effects. Some people experience short-term pain relief but others do not. A long-term solution to chronic pain will require an improvement in movement function which takes time, patience and proper guidance. Weigh these factors before making your decision.
Our team at Upright Health does not believe in joint injections and actively encourages clients to stay away from them. However, if you’re steadfast on your decision, at least understand why you’re doing it and what the risks are.
Remember:
- Injections do not provide a long-term permanent solution to joint pain.
- Injections are not a useful diagnostic tool to determine whether pain is coming from some damage “in the joint.”
- Injections can have serious side effects and are not as safe as commonly presumed.
By using a steroid injection to temporarily relieve pain, you’re telling your brain that there is nothing wrong with the way your body functions. So chronically shortened muscles or weak and atrophied muscle will remain dysfunctional (and cause you pain once the injection's effect wears off).
Even worse, because we’re numbing our body’s natural feedback mechanism, we might engage in activities that place these muscles into even more dysfunction. The imbalanced muscles can send out signals of pain. They can also pull bones into problematic/unstable/painful positions. By the time the numbing agent wears off, it is no surprise that our pain comes back even worse and that there is a possibility for greater pain.
The only way we advocate getting out of pain is to learn your individual muscle imbalances and compensations. Learning how the body optimally functions and how your body deviates from that provides you with a roadmap for recovery - and more!
This isn’t a quick fix. It requires time, experimentation, and persistence.
Nothing of value in life comes easy or quick, so don’t be fooled by the “quick fix” promise of steroid injections for joint pain.
