Steroids-The Therapeutic “Frenemy”

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We at CHARM are open and performing procedures. Under Gov. Abbott’s guidelines, only hospital-based procedures are being limited at this time. It is especially for us to continue working because the more we can help people in our clinic, the greater the amount of hospital resources are available to help those with more severe conditions, such as complications of COVID-19.

Two of the tools we can employ to help folks include steroid injections and orthobiologic, or regenerative medicine, treatments such as platelet-rich plasma (PRP) as well as PRP combined with bone marrow aspirate concentrate (BMAC/PRP), commonly referred to as “stem cell” treatment.

We perform steroid injections every day at CHARM and will continue to offer this because steroid injections can be an excellent tool in reducing acute, and/or severe pain. The purpose of steroids, is not to “fix” a problem, but rather to calm things down so people can sleep, work, move better and participate in rehabilitation. When we focally inject steroids using X-ray or ultrasound guidance, we can specifically target structures to provide a more specific treatment with a much lower dose of overall steroid compared to systemic treatments like oral steroids or intramuscular steroid injections.

The downside is that steroids can be bad for you in the long-run. The steroids we give are catabolic, as opposed to the anabolic steroids that athletes have gotten in trouble for. So instead of building up tissue, catabolic steroids can break down tissue as well as lowering the immune system. Steroids work by stopping the body’s inflammatory process. This inflammatory process is important for tissue healing, but can be uncomfortable. So, when we stop inflammation, we provide pain relief, but this can precipitate a delayed healing response. This is akin to fanning a fire. The fan can put out the flames temporarily, but may also end up making the fire worse. Because of this, we must be very judicious in how much, and how often, we inject steroids. Currently, the Spine Intervention Society recommends to prioritize procedures that use steroids and use the smallest dose necessary. There is no current study that examines whether or not a steroid injection increases the risk of contracting COVID-19, or alters the course of a subsequent infection.

Contrary to steroids are regenerative medicine treatments like PRP and BMAC/PRP. These treatments really work in an opposite manner compared to steroids. Whereas steroids provide quick pain relief, they are ultimately bad for the body. When we utilize PRP or BMAC/PRP, we are trying to promote the body’s inherent healing capacity to promote tissue health and repair. The downside of this therapy is that patients are often sore for a few days after treatment. The ultimate goal of this therapy is to provide long-term relief by addressing the structural damage that is contributing to pain. Steroids may lower the immune system, but PRP and BMAC/PRP do not negatively affect the immune health and may even incur a protective effect by delivery of growth factors and white blood cells to areas that otherwise have little exposure to these components.

The COVID-19 crisis has forced us all to re-evaluate our lives and our clinical practices. While we will continue to offer steroid injections at CHARM, the safer alternative, especially now, is clearly regenerative medicine treatment with PRP and BMAC/PRP.

 

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