Esi

OOH, boy- two controversial questions!

Ok, "how many" has been and continues to be a topic of some debate- Many talk about 3 shots and you're out--However, the number is not the key-Bottom line- it is really patient specific, ie- depends upon the dosage of steroid per injection and over what period of time- Let's take methylprednisolone for example:

- dosages per injection can vary from 40mg to 120mg
-3 injections at 40 mg= 120mg total
-3 injections at 120mg= 360mg -- see the point?

Steroids mimic the action of Cortisol- Cortisol production is controlled by adrenocorticotropic hormone (ACTH), which is released from the pituitary gland at the base of the brain. The pituitary responds to a range of signals to release ACTH which, in turn, stimulates cortisol release by the adrenals.

Too much steroid over time?-The following effects usually come about over time, and are related to the dose and duration of treatment. More rarely, side-effects occur as a result of abnormal secretion of ACTH by the pituitary gland. The effects of too much cortisol include:

-weight gain in the face, chest and abdomen with weight loss in the legs and arms (Jerry Lewis)
-muscle weakness
-avascular necrosis of the large weight bearing joints
-thinning of the skin with increased bruising and poor wound healing
-diabetes
-high blood pressure
-immune suppression with increased infections
-osteoporosis

The key then, as it is with anything is proper patient selection, use the least dose possible, and allow time in between series of steroid use.
-BTW- also consider any oral steroid use and any injections elswhere in the body (knee, shoulder, etc) when considering peridural steroids

In terms of benefit, corticosteroids have the greatest anti-inflammatory effect available but that is the key- They only work if there is inflammation-

ESI's work as well for spine related pain as do joint injections of the knees, shoulders, hips, etc- Many times it is miraculous and in other conditions, it does not help at all

I have many patients who receive up to 3 injections (4 in rare cases) in a 10-12 month period and others who require 1 injection every 3 months- In many other cases, patients can go for years with relief- Again, one must use careful patient selection. Regardless of the area of medical treatment, one must treat the individual- This is the means by which we apply the science to the art-

Keep in mind- such treatment is NOT typically curative in degenerative states but rather a treatment and control of a disease process for which there is no good "fix".