What are opioids and why are they dangerous?

When taken as prescribed by your doctor, opioid medications can safely help manage severe pain, such as the kind experienced after surgery. However, there are risks if these medications are not used properly.

The same qualities that make opioid medications effective for pain relief also make them potentially dangerous.

At lower doses, opioids can cause drowsiness, but at higher doses, they may slow your breathing and heart rate, which can be fatal. The sense of pleasure or euphoria that opioids provide can also lead to a desire to take them more frequently or in higher doses, increasing the risk of addiction. Addiction occurs when opioids have such a powerful effect on the brain and behavior that they disrupt your ability to control their use.

You can lower the risk of serious side effects by carefully following your doctor’s instructions and only taking opioids as prescribed. Be sure to inform your doctor of any other medications and supplements you’re taking. Discuss the benefits and risks of using opioids for pain management, and ask about alternative pain.

What are the benefits and downsides of Cortisone (steroid) injections?

Cortisone shots, or steroid injections, deliver medication directly to a specific area in your body that needs relief. Corticosteroids in these injections help reduce inflammation, making them useful for treating conditions such as arthritis, tendinitis, and bursitis.

What are cortisone shots (steroid injections)?

A cortisone shot is an injection that helps relieve pain and reduce inflammation (swelling). Healthcare providers may also refer to these as steroid injections or steroid shots—they all refer to the same treatment, which involves injecting a dose of corticosteroid into the body.

Corticosteroids are lab-made drugs that closely mimic cortisol, a hormone naturally produced by your adrenal glands. They work by temporarily suppressing your immune system’s activity to reduce inflammation.

Providers commonly use cortisone shots to treat inflammation in various joints, including:

Shoulders
Spine
Hands
Hips
Knees
Feet

Your provider may also use cortisone shots to treat inflammation in tendons or bursae—the fluid-filled sacs that help cushion the spaces around and between your joints, tendons, and bones.

Which conditions are treated with cortisone shots?

Cortisone shots can be used by healthcare providers to treat a variety of conditions that cause pain and inflammation, including:

What does a cortisone shot do?

A cortisone shot helps reduce pain and inflammation in the area where it is injected.

Inflammation typically occurs when your immune system sends cells to fight infection or heal an injury. By injecting cortisone directly into the inflamed area, your provider can calm the immune response at that specific location, which decreases pain and inflammation.

Does a cortisone shot affect the whole body?

Your provider will inject cortisone directly into the inflamed area of your body, delivering the corticosteroid precisely where it’s needed.

While the steroid medication does circulate through your bloodstream and may have some effects on other areas of your body, these systemic effects are generally minimal and typically go unnoticed.

Risks/ Benefits

What are the benefits of cortisone shots?

Cortisone shots are a safe and effective option for relieving pain and inflammation. They can help you manage symptoms or conditions that may make it difficult—or even impossible—to engage fully in your daily activities.

What are cortisone shot side effects?

The most common side effects of cortisone (steroid) shots include:

Pain at the injection site
A temporary increase in swelling
Bruising
Temporarily elevated blood sugar levels (people with diabetes should monitor their blood sugar more frequently for about five days after the shot)
Redness or discoloration of the skin at the injection site
Skin lightening or paleness near the injection site

Although it is rare, steroid injections can cause more serious side effects, such as:

Infections at the injection site
High blood pressure (hypertension)
Fluid retention and increased swelling
Increased risk of osteoporosis in individuals who receive multiple rounds of steroid injections.

When should you not get a steroid shot?

You should not receive steroid injections if you have an infection, as corticosteroids have a short-term immunosuppressive effect that can make it harder for your body to fight off infections and heal properly.

Additionally, people who take blood-thinning medications (anticoagulants) or have bleeding disorders, such as hemophilia, may not be suitable candidates for steroid injections. Be sure to inform your provider about any existing conditions you have and how you’re managing them, including all medications and supplements you’re taking.

How long after a cortisone shot will I feel relief?

The time it takes for a cortisone shot to work can vary from person to person. Your symptoms, such as pain and inflammation, may not improve right away—it can take up to a week for the cortisone shot to take effect. If you haven’t noticed any improvement after 10 days, be sure to talk to your provider.

How often can you get a cortisone shot?

You may only need one cortisone shot to relieve pain and inflammation, particularly if you’re recovering from a temporary injury. However, if you have a chronic (long-term) condition, you might require additional steroid injections in the future.

Your provider will advise you on when it’s safe to receive another dose. Generally, you’ll need to wait at least three months between injections. Most people should not receive more than three shots per year.

How long does a cortisone shot (steroid injection) last?

Everyone’s body responds differently to a cortisone shot. Typically, the effects of steroid injections last anywhere from a few weeks to a few months. If you’re recovering from an injury, the cortisone shot should provide relief long enough for your body to heal completely.

For chronic inflammation, you may notice your symptoms gradually returning over time. If you experience new or worsening inflammation, be sure to discuss it with your healthcare provider.

Platelet-Rich Plasma (PRP)

Platelet-rich plasma (PRP) injection is a biologic therapy that promotes healing and enhances repair in certain injuries. Often referred to as an “orthobiologic,” PRP is derived from a patient’s own blood, which is then centrifuged to concentrate the platelets for treating orthopedic injuries and conditions. PRP injections can be a beneficial alternative for managing tendon, ligament, muscle, and cartilage injuries.

The PRP treatment process is relatively simple: the doctor draws blood from the patient and uses a centrifuge to isolate the PRP. This concentrated mixture contains platelets, cytokines, growth factors, and anti-inflammatory properties, which are injected into the injury site to stimulate healing. PRP can also be used during surgery to enhance recovery and improve healing speed.

PRP has been used for years to treat professional athletes and is increasingly being utilized to help active adolescents and adults recover from sports and other orthopedic injuries.

What is a platelet rich plasma (PRP)?

Blood consists of four primary components: plasma, red blood cells, white blood cells, and platelets. Plasma is the liquid part of blood, with about 90% of it being water. Red blood cells carry oxygen, while white blood cells help the body respond to infections and injuries. Platelets are tiny cell fragments in the blood that play a crucial role in clotting and act as one of the first responders to an injury. When platelets reach the injury site, they become activated and release growth factors and proteins called cytokines, which aid in the healing of damaged tissues.

Platelet-rich plasma (PRP) is a therapy created from the patient’s own blood, consisting of plasma and a high concentration of platelets. It is injected directly into the injured area, delivering a concentrated dose of platelets, along with growth factors and cytokines, to promote healing.

To prepare PRP, a doctor will first draw your blood and place it in a centrifuge, a device that spins rapidly to separate the components of blood. The centrifuge separates red blood cells from the plasma and platelets. After the red blood cells are discarded, what remains is a mixture of plasma and concentrated platelets. PRP typically contains three to five times the number of platelets found in normal circulating blood. It also contains white blood cells, or leukocytes. If PRP is prepared with a higher-than-normal level of white blood cells, it is referred to as leukocyte-rich PRP. If it has a lower-than-normal level of white blood cells, it is called leukocyte-poor PRP.

What problems can platelet rich plasma injections be used to treat?

Platelet-rich plasma (PRP) injections are used to treat degenerative conditions such as osteoarthritis, as well as injuries to tendons, ligaments, and muscles. At Yale Medicine, orthopedic surgeons, sports medicine specialists, and physiatrists use PRP injections to help people of all ages.

Some specific conditions that doctors treat with PRP injections, or use PRP as a supplement to other treatments like physical therapy, include:

Neck and back pain
Chronic ligament or tendon injuries
Golfer’s elbow and tennis elbow
Osteoarthritis in the hip, knee, or shoulder joints
Rotator cuff injuries
Injuries to cartilage, ligaments, and tendons

PRP can also be used alongside surgery to improve healing and speed up recovery.

What kinds of results can patients expect with platelet rich plasma injections?

Every patient responds differently to PRP treatment, but doctors believe it may promote a longer-lasting recovery from an injury compared to some other treatments. Some patients report pain relief within four to six weeks—sometimes sooner—and notice continued improvement for up to a year.

It’s important to note that the effectiveness of PRP treatments can vary between patients, and doctors are still researching the reasons behind these differences in outcomes.

What are the risks to platelet rich plasma injections?

Platelet-rich plasma (PRP) injections are minimally invasive and rarely cause side effects. Since PRP is derived entirely from the patient’s own body, there is no risk of rejection or disease transmission. The most common side effects are mild discomfort, pain, or stiffness at the injection site.

Spinal Cord Stimulator (SCS)

Back pain is one of the most common forms of chronic pain in the country, and its underlying causes can vary widely.

When back pain persists and doesn’t improve on its own, it may be due to several factors. Common causes include:

Failed back surgery
Complications from back surgery
Peripheral neuropathy
More generalized issues, which are determined through:
- An in-depth consultation
- X-rays
- Lab tests

The good news is that, regardless of the root cause, there are many solutions available that go beyond pain relievers and invasive surgeries.

One of the most common tools that Dr. Iqbal relies on for addressing back pain is Spinal Cord Stimulation.

How does Spinal Cord Stimulation Work?

Spinal Cord Stimulation (SCS) is a relatively simple and minimally invasive outpatient treatment that can provide significant relief.

In this procedure, a small device is implanted just under the skin in a targeted area. This implant delivers mild, nearly imperceptible electrical impulses that interfere with pain signals before they reach the brain.

Advancements in technology have led to remarkable improvements in these devices, such as the Stimwave Wireless Stimulator System, which can be easily controlled through a Wearable Antenna Assembly that clips discreetly onto your clothing.

After undergoing Spinal Cord Stimulation, many patients experience far-reaching and noticeable improvements in their condition soon after the procedure. Most report increased mobility, reduced pain, improved function, more activity, and an overall better quality of life.

The benefits of Spinal Cord Stimulation include:

Reduced reliance on opioids or other pain medications
Lower chances of needing extensive surgery for long-term pain relief

Is Spinal Cord Stimulation right for you?

Patients who have experienced failed back surgery or are dealing with peripheral neuropathy may be excellent candidates for Spinal Cord Stimulation. However, determining if this is the right treatment for you starts with a consultation with Dr. Iqbal.

Together, we will thoroughly review your:

Medical history
Past treatments
Current pain levels
Goals for treatment

From there, we’ll create a personalized plan tailored to your specific needs, aiming to effectively address your pain and provide long-term relief.

Remember, regardless of how long you’ve been struggling with back pain, there are options available that don’t rely solely on medications for symptom relief or major surgeries with long recovery times.