Episode 12 | When Do You Really Need A Corticosteroid Shot For Your Pain?
"Hey, everyone, this is Dr. Chad Kuntz and welcome back to Prime Time. We are on Episode Number 12 where we're going to discuss, when do you really need a corticosteroid shot for your pain?
So if you've been in pain at one time or another when you ran into your general physician, your sports and or orthopedic doctor, the topic corticosteroid shots probably popped up at one time or another. And for most of us, we trust the doctor. They've done their homework. They've gone through all schooling and so if they suggest that we need one, we're usually on board. I'm just here to help give you guys a little bit more information and background on my personal clinical side of things having seen the effects of corticosteroid shots, and understanding now the timing in which you could best benefit from a corticosteroid shot. And perhaps some of this information can be super helpful for you guys at home.
So first we have to know what a corticosteroid shot is. A corticosteroid shot mimics cortisol. Cortisol is produced by the human body from the adrenal glands that sit just on top of the kidneys. Every morning, it's usually produced more so in the morning than any other time, however, should you be in a lot of stress in fight-or-flight, that's when cortisol is produced. So cortisol has very strong anti-inflammatory properties. That is most likely the main reason that it is favored in a corticosteroid shot. Because oftentimes if you're in pain, you have a lot of inflammation, so you need to fight chemistry with anti-chemistry, so to speak, and so, therefore, you knock out the inflammation with an anti-inflammatory effect. However, did you know that corticosteroids can actually start to weaken cartilage? They can actually degrade tissue that we're finding out now, most recently. Did you know that you're only supposed to have up to three of these performed, per year, in the entire body, because of their strong effects, strong negative side effects? They can actually promote muscle wasting and they can actually promote a decrease in bone density. In fact, if you have an excessive amount of cortisol for prolonged periods of time you can actually end up with osteoporosis, which is a severe weakening of the bones. In fact, it has also been shown to lead to something quite nasty called avascular necrosis most oftenly seen in the hip. And that's when the hip actually doesn't receive enough blood supply and that's not a good situation. So for all of these reasons, we have to be really more so mindful of when that corticosteroid shot is performed. Now, of course, if you have a corticosteroid shot every now and then, you're most likely at minimal risk for all those things I've just said. However, if you are a diabetic, do understand that this is gluconeogenic, and what that means is that it'll actually increase the amount of glucose in your bloodstream. So if you are monitoring that quite diligently, you would wanna know and monitor the amount of glucose that you have flowing through your serum or through your blood supply because you wanna make sure that doesn't get out of hand.
So when or who is the right candidate for these corticosteroid shots? Since there are so many side effects, why is it being performed so often? These are great questions. I'm here to kind of help you guys sift through it a little bit and kind of give you my personal take on this. I think one flaw of... this is more so even the healthcare system, is that we're just so reactive. We're so reactive and we jump to the most extreme resolution right away. And I think one example of that is a corticosteroid shot. Let's say I have developed right shoulder pain. It came out of nowhere, I'm not sure what's going on, I'm going to call it a 5 out of 10 pain but it's really you know bothering my quality of life, inhibiting my quality of life. It's making it tough for me to pick up my kids and it's making it tough for me to work. What do I do? Well, a lot of times I think right now in the population, we go right to our general physician. General physician goes, you know, you probably need to see an orthopedic doctor. They refer you out, they might do X-rays, which in my experience, most often doesn't really show anything. And then they suggest well we probably wanna, you know, not perform surgery right now but you would benefit from a corticosteroid shot. People undergo that process, okay? Now a lot of times, it does probably help but what is it really helping? It's probably helping the inflammation but it's not addressing the root cause. So now you've put yourself up for some severe side effects or possible side effects, and you haven't even addressed the root cause of it.
In fact, I had this sweet lady that had a corticosteroid shot performed for her knee didn't even know that she could receive care for it. And she had a severe reaction to it in the sense that it kind of gave her, if you guys are familiar with frozen shoulder, it pretty much gave her that in her knee, to the point that she couldn't even bend her knee and she had a huge autoimmune reaction to it. So all of a sudden, she had really high inflammatory levels and markers in her blood throughout her body. And she didn't even know that her knee could have been treated by someone and she could have foregone the corticosteroid shot. I'm sure you could imagine that made her quite unhappy.
So the point I'm trying to get to here is we need to address the root cause to figure out what the heck is causing that inflammation first. And knowing that these have such serious side effects, isn't it worth attempting conservative care for just 30 days to see if we can discover what the actual root cause is, which by the way you're gonna have to end up figuring out anyway? And seeing to what extent we can decrease that inflammation in that joint or in that muscle or in that tendon without a corticosteroid shot and save you all that worry.
So if you are in pain, and even though it's pretty significant, at a minimum, I would say find a practitioner that you trust. Find someone that can give you one on one care. I would prefer you to see someone with no techs, no aides, no assistants or anything like that, and to find a specialist, to find the best, okay. Find the best healthcare provider or providers that can give you the time of day to give you a good subjective history. Have a discussion what's going on because there might be actually something quite a simple answer there. You got a new job, you're doing something and moving a different way all the time. You began a workout program and maybe it's a certain movement that's just simply causing some inflammation because you're not doing it right. Yet you're gonna go to an extreme and get a corticosteroid shot when it could be like, you know, a quite simple fix in just 30 days. Isn't that worth it?
There are some cases, some cohorts of people, where corticosteroid shots have been shown to be maybe and arguably the most effective. The one that comes to my mind is a frozen shoulder. So a frozen shoulder, kind of an idiopathic meaning, unknown cause that's going on. There are some relationships like if you're a middle age female, if you're diabetic if you have thyroid problems, you might be more likely to have a frozen shoulder. So that kind of person might benefit from a corticosteroid shot sooner rather than later. But I wanna be honest. I'd still wanna identify her and give her a clinical diagnosis of frozen shoulder. And I'd still wanna see if she could benefit from our care for 30 days and within that 30-day timeframe to see what effect we could make changes on it. And guess what if we can't make changes in those 30 days let's go ahead and let's go through that corticosteroid shot. In fact, that's quite a common recipe for me anywhere in the body. If you have pain and it's just been stubborn, we can't get rid of it, well, sometimes you do need to take that firehose and put out the fire before you can begin with mechanical improvements.
So, guys, I hope that helps. That's a lot of information. Corticosteroid shots are talked about all the time. We wanna have a little bit more information about this. We wanna have a little bit more autonomy in our own pathway for our health. We wanna be educated so that we can make the best decisions in our journey throughout that point in time. And that was really the main purpose about this Prime Time session.
So thank you guys for tuning in. Feel free to email me any questions at firstname.lastname@example.org again that's email@example.com. Thank you, guys."
Episode 12 | When Do You Really Need A Corticosteroid Shot For Your Pain?
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