Epidural Steroid Injection While on Prednisone--dangers?
Posted , 9 users are following.
I'm scheduled for an epidural steroid injection in my neck (C3) on 10/24 to treat neck pain/numbness I've had for over 2 yrs. I also had a cortisone injection in my hip in July. I am on 8 mg prednisone for PMR.
Reading about epidural steroid injections, I see they can suppress adrenal function and ACTH. The danger of suppression (and the degree of suppression and length) seems connected to repeated injections. I couldn't find information about how being on prednisone might affect this. I started on pred on Christmas day 2017, so it's been almost a year. Started on 10 mg, got down to 3 mg at one point, but had to go back up to 9, and now stuck at 8.
I'm kind of scared about the collective impact of pred plus hip injection and now neck injection. Does anyone have any information on this or advice?
Thanks.
0 likes, 14 replies
ptolemy jeannecatlover
Posted
As you have been taking steroids since last Christmas your adrenal glands are already suppressed. The steroids produce enough cortisol so they can go on holiday. Once you get down to around 7.5mg of pred they will have to start working again as the steroids will not be supplying enough for them at that dosage which would have happened when you went down to 3. The epidural in your neck should be fine.
Susanne_M_UK jeannecatlover
Posted
I asked my rheumatologist that question yesterday, as I may be having steroid injections in my spine. I was told that, as the injections are local, they don't affect my general prednisolone intake, which is currently 10mg.
jeannecatlover Susanne_M_UK
Posted
I know that is not true. I've just read 4 different medical journal articles talking about adrenal suppression from steroid injections. The steroids do get into your system. For most people, the suppression lasts only a month or so and everything returns as normal. But for some people, adrenal function doesn't return for a year and requires stimulation and treatment that I don't fully understand yet.
Some articles express concern over patients with other sources of steroids, such as previous injections or prednisone. But it's not clear to me that the people who have trouble getting their adrenal function back are those who have other sources of steroids in their system. That's the piece of info I'm still missing.
EileenH jeannecatlover
Posted
You are at a dose where adrenal function is unlikely to be normal anyway - 8mg is the level that means the adrenals don't need to produce any more anyway, adding a temporary boost via the epidural is unlikely to make much difference. Once the extra steroid works its way out of your system and isn't topped up again, then the adrenals will be able to start to produce cortisol but only after the daily dose gets down to nearer 5mg than 8mg.
Michdonn EileenH
Posted
Hi EileenH, I am at 5.5 tapering to 5 and they want to give me an epidural. I am not crazy about the idea, but what are your thoughts on this idea? Thanks as always for your help! I trying to stay positive and smile. 🙂
Anhaga Michdonn
Posted
Just curious, why do they want to give you an epidural?
Michdonn Anhaga
Posted
Hi Anhaga , the doctors think that a lot of the trouble I am having with my hip and leg is from my back. I don't agree, but the way they are delaying doing anything i might be healed by the time they want to do the procedure. I am hoping anyway. Here hoping still positive with a little less smile.🙂
Anhaga Michdonn
Posted
Seen a physiotherapist lately? Mine managed to stretch my spine out enough to relieve what must have been pressure on nerves causing hip and back pain. This pain, btw, preceded PMR/pred but wasn't treated until I went to the physiotherapist after diagnosis, and also to help with osteoarthritis and "low bone mass". Getting rid of the hip pain was a pleasant side effect because I don't think I ever mentioned it to her!
Michdonn Anhaga
Posted
Hi Anhaga, I go tomorrow, I know I will walk out feeling like a new man. I really started to believe, that with his help i probably will not get the epidural. I also believe that the doctors are jumping to a conclusion because I have pain down the which I believe is being caused by the stained muscles and the tear in the labrum. Thinking positive with a smile.
🙂
EileenH Michdonn
Posted
Sorry for the delay replying - travelling!
Have you had a second opinion? They were thinking of trying something like that for me but the conservative approach worked fine: physiotherapy and needling resulted in the muscle tension relaxing and the nerve irritation subsided.
amkoffee jeannecatlover
Posted
All I can tell you is my own personal experience . I have had numerous steroid injections in my lower back. and I've had them while on steroids and on a much higher dose than what you're currently on. I have also had the injections following something called a trigger point injection which is also steroids. the reason for that was because the trigger point injection (a trigger point injection is where they put the steroid into the muscle.) didn't help so we scheduled a spinal injection. in any event I have had no problems with it. I haven't had it help but it hasn't hurt me either. there is a lot to be gained by these injections but there is a risk of it causing permanent lifelong problems. I can't think now of what they call it but I'm sure you can search online for it. It's a condition that happens following a steroid injection in the back. I know yours is in the neck but it's still the spine so I don't think it makes a difference. I hope this injection helps you and if you have any questions about what it's like feel free to private email me.
jeannecatlover
Posted
Thanks very much for all the replies. This is very helpful. I heard back from my doctor yesterday (the one giving me the injection today), and he said it was no problem to give me the injection while I'm on pred. He gave no further explanation, so I'm very glad for your comments, which help me to understand this whole situation better.
Hoping I will have good news to report after the injection kicks in.
jeannecatlover
Posted
I received the injection yesterday. The doctor agreed with EileenH and ptolemy that my adrenals were already suppressed, but when I asked for more info and whether my adrenals would kick in when pred reduced, he just made a face like being on pred is an awful thing and who knows what will happen. He doesn't have the best people skills. Hopefully he's good at injecting. All I can tell so far is that neck is sore.
From my research, it sounds like adrenals are suppressed for a month after injection (if they weren't already), so my guess is that it would be unwise to reduce pred from 8 mg to 7 mg (using DSNS) until a month has passed. It seems to me that if I try to reduce, the injection will prevent adrenals from kicking in. Does that make sense?
EileenH jeannecatlover
Posted
The oral pred dose at 8mg has nothing to do with your adrenal function and it is only by reducing the oral dose that you will get adrenal function to return. In fact, after a steroid injection is a good time to try small reductions - they often go more easily. It will take some time for adrenal function to return and it will return slowly, not overnight, so it will make little difference.