Why Didn’t My Pain Improve After a Steroid Injection?
Steroid injections are a highly effective treatment for many individuals suffering from pain related to inflammation. For most people, these injections bring significant relief, allowing them to return to their daily activities with reduced discomfort. However, there are instances where the expected results don’t materialise. If you’ve had a steroid injection and your pain hasn’t improved, it’s important to understand the potential reasons why.
Below, we outline 10 possible explanations:
1. Not Enough Time!
Steroid injections can sometimes seem to work almost immediately, but this isn’t always the case. More often, there’s a gap between receiving the injection and feeling its effects, as it can take time for the inflammation to settle, especially if the pain has been present for a long period. Most research suggests that steroid injections typically take 3-5 days to take effect. However, it does vary from person to person, and condition to condition, and it can take 2 weeks for a steroid injection to take effect. The steroid can remain in the body for 3 to 4 weeks (depending on the steroid used). During this time, a delayed effect can occur, so patience is essential!
2. Severity of the Condition Being Treated
The effectiveness of a steroid injection can be influenced by the severity of the condition. In some cases, the condition may be too severe for a steroid injection to make a significant impact on pain relief or quality of life. For example, in cases of severe osteoarthritis (OA) in the knee or hip, a steroid injection might be less likely to help. In such situations, it might be time to consider a consultation with an orthopaedic surgeon to explore other treatment options.
3. Previous Steroid Injections
The law of diminishing returns applies to steroid injections. The more injections you’ve had for the same condition, the less effective they may become over time. This is why it’s important to space out steroid injections wherever possible to maintain their effectiveness.
4. Inaccurate Injection
The accuracy of the injection plays a crucial role in its effectiveness. At our clinic, all injections are carried out under ultrasound guidance to ensure precision and optimal results. There is extensive evidence showing that ultrasound-guided injections are much more accurate, safe, and effective than non-guided injections. If you’ve previously had an injection that wasn’t guided by ultrasound and it didn’t work, we might suggest trying one under ultrasound guidance for better accuracy and effectiveness.
5. Inaccurate Diagnosis
Successfully treating a condition requires an accurate diagnosis. A combination of clinical questioning and diagnostic imaging (such as ultrasound, MRI, or X-ray) is crucial to identify the primary cause of your pain. At our clinic, we prioritise accurate diagnostics and, if necessary, will refer you for further imaging, such as an MRI. We believe that without a confirmed diagnosis, a steroid injection may not be effective, and we make it a point not to guess when it comes to your health.
6. Multiple Sources of Pain
In some cases, multiple conditions can contribute to your pain, making it challenging to determine the primary cause. For example, a patient might suffer from both carpal tunnel syndrome and a trapped nerve in the neck, both of which can cause similar symptoms such as pins and needles, numbness, and weakness in the hand. By treating one condition at a time, such as injecting the carpal tunnel, we can gain valuable insights into which condition is most symptomatic. Similarly, overlapping pain from conditions like trochanteric bursitis and hip joint issues, or referred pain from the back (such as sciatica), can be better understood through targeted injections.
7. Lost Window of Opportunity
A steroid injection is a powerful anti-inflammatory treatment that should be used to reduce pain and inflammation, allowing you to address the underlying cause of your symptoms. While a steroid injection typically has a lifespan of about 3 months, it’s important to note that in some cases, the relief can last much longer, and occasionally, even provide permanent relief. To maximise this window of opportunity, it’s crucial to follow a specific rehabilitation programme under the guidance of a physiotherapist. Neglecting this post-injection rehabilitation can lead to a recurrence of pain and symptoms. Think of it as a combination treatment—both the injection and physiotherapy are essential for long-term improvement.
8. The Condition Treated Was Not Inflammatory
Steroid injections are most effective for treating inflammatory conditions. However, some conditions, like osteoarthritis, can fluctuate between periods of relative calm and periods of inflammation. For example, an osteoarthritic knee might generally feel stiff and achy, especially in the morning or during activities like climbing stairs. But during a synovitic flare-up (when the inner membrane of the joint becomes irritated), the condition becomes more inflammatory, making a steroid injection more effective. Understanding when your condition is in an inflammatory phase is crucial for the best outcome.
9. Wrong Type of Steroid
In the UK, two different types of steroids are commonly used to treat musculoskeletal conditions: Depomedrone and Kenalog. Although these medications are similar in chemical makeup, it’s not unheard of for someone to respond better to one than the other. If you’ve had a previous positive response to a steroid injection, it’s worth knowing which steroid was used. Since individual responses to different drugs can vary, a second injection with a different steroid may be recommended if the first was not effective.
10. Incorrect Dosage or Administration Technique
In some cases, the dosage of the steroid or the technique used to administer the injection might not be appropriate for the condition being treated. If the dosage is too low, it may not provide the necessary anti-inflammatory effect, and if the administration technique is not optimal, the medication may not reach the intended site effectively. Consulting with your healthcare provider about the specific dosage and technique used could be important in ensuring the best possible outcome from the injection.
If your pain hasn’t improved after a steroid injection, it’s worth considering these factors. At our clinic, we’re always happy to discuss whether injection therapy could help you. For more information or to book a consultation, please email us at info@complete.com or call us on 020 7482 3875.