10 Aug 2008 04:12 pm

Writer’s Block August 10

August 10, 2008

Sciatica and the Epidural: Part Three

The Difference Between Corticosteroids and Anabolic Steroids

As I reported in my last post on Sciatica and Epidural Injections, I’ve received a number of emails asking some very well thought-out questions, expressing opinions (both pro and con) and generally requesting more information on the subject.

Suffice it to say there seems to be a great deal of interest in this subject but still a little misunderstanding regarding steroids and their therapeutic purpose. Naturally, this could potentially lead to fear, disappointment, and less than ideal outcomes. Therefore, I think it’s important that we address the following questions:

But Aren’t Steroids Evil?

Darth Vader

Hmmm… evil. That’s a good question. I don’t know if chemical compounds have character flaws, but I’m sure if they did evil would be right up there at the top (along with my other two favorites, gluttony and sloth).

And speaking of individual shortcomings, did you know that Vitamin D is a steroid? (Oh, the shame of it… and he was always so well behaved as a nutrient.)

By the way, as you can probably guess, no one actually came right out and asked me if steroids were evil. I sort of made that one up because it reflected the underlying tone of some of the correspondence I’ve received.

The fact of the matter is, Vitamin D is a steroid and so are a number of other familiar substances we come in contact with daily including cholesterol. (I’m tempted to make a “good and bad” cholesterol joke, but I’ll spare you.)

The point of all this is to illustrate that the term steroid is simply the name given for an entire class of compounds with a similar chemical structure. Many of these compounds are produced naturally in our own bodies (like the hormones estrogen and testosterone) and are really just a common part of everyday life.

There is no reason to fear them simply because they are classified as steroids. Which brings us to the next question:

What’s the Difference Between Corticosteroids and Anabolic Steroids?

This whole cloud of fear that hangs over the subject of steroids seems to be fueled in part by all of the negative press surrounding one specific class of steroids. We hear the word steroid and we automatically associated it with anabolic steroids.

This results in questions like…

  • Won’t steroids cause me to bulk up?
  • Will I start to grow facial hair?
  • Don’t steroids cause hormonal changes?
  • What about birth defects?

bodybuilder2

Without question, the biggest misunderstanding with epidural injections is confusing them with anabolic steroids Anabolic steroids are very different from the corticosteroids used to fight inflammation.

Anabolic steroids are synthetic male sex hormones designed to promote muscle growth. Corticosteroids are not sex hormones and they don’t stimulate muscle growth, enhance athletic performance or produce secondary male characteristics.

So you don’t have to worry about bulking up or altering your hormonal balance.

Isn’t This Just Treating The Symptoms?

Yes, this is a symptomatic approach to treating the problem. You are not treating the real underlying cause of the nerve damage.

As I’ve said all throughout this series, the purpose of the injections are so you can proceed with a good rehabilitation program. They aren’t meant to act as a cure. You still have to do the work if you want to correct the problem.

It is important to understand that the injection is just a temporary tool you can use to buy yourself a little time.

The All-Natural Question

Yes, I must admit, that the corticosteroids your doctor will use in the shots are artificially created in a laboratory. They have to be in order to get a precise controlled dosage that can be delivered right to the spot where it’s needed.

So while they are closely related to the natural cortisol produced by the adrenal gland, they are not exactly the same thing.

Even if there were a natural source of these anti-inflammatory steroids — because of the risks involved with taking this medicine — it would not be wise to simply start taking them in a random unknown dosage.

This is one of those times when the treatment is best left in the hands of medical science.

In the next installment, we’ll take a closer look at the risks involved with epidural steroid injections. So stay tuned.

In the mean time, if you’re still concerned about what impact the procedure would have on your long-term health, keep in mind that we’re talking a total of six days on the oral steroids and only three injections.

You probably did more damage that one weekend in college. (You know the one.)

stoned

References:

1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

******************

One Response to “Writer’s Block August 10”

  1. on 14 Aug 2008 at 6:04 pm 1.Debbie said …

    I’ve been living w/chronic back pain since a fusion at the L5-S1 approx. 16 yrs. ago. I’ve had numerous cortizone injections through out the yrs. to help relieve back pain & other problems that were created as a result of that successful fusion (they tell me). I have been one of the lucky ones that gets relief from these injections which are meant to reduce inflammation in the corresponding nerve.

    I asked a Dr. one time if I should be concerned w/these injections & he told me “no” that ultimately you get such a small amount injected directly into the problem area that I shouldn’t be concerned. None of my Dr.’s prescribed “oral” cortizone a/k/a 6 pack while experiencing a flare-up. I don’t believe there is anything wrong with “oral” cortizone……..it’s just that the injections goes directly to the problem instead of circulating through out the system hoping to find the problem.

Trackback This Post | Subscribe to the comments through RSS Feed

Leave a Reply