Steroids during and after the pandemic

22nd April 2020

You might have heard that steroids are not good as they can cause many complications and are not free from side effects, some of them serious. The issue has become even more acute in the time of coronavirus pandemic. Why is that? Let me explain.

What do steroids do?

Steroids are hormones produced by our body or by pharmaceutical companies. The former play role in regulating certain physiological processes in our body, such as immune response, water and salt physiology, metabolism, inflammation and many more. Steroids made by pharmaceutical companies mimic the natural ones. Patients take them for many diseases like for instance rheumatoid arthritis and after organ transplants. They are also widely used as an injection for pain conditions caused by inflammation.

How do steroids work for pain?

Pain is caused by inflammation. Inflammation is how our own body responses to injury and trauma. Our immunology system sends several various cells to inflamed area in order to contain inflammation in this area, get rid of it and heal the injured tissue. Unfortunately this process is painful. And if the inflammation is chronic, like in osteoarthritis, the pain is chronic as well. And here come steroids. One of their mode of action is to suppress immunology system and stop body’s natural response to inflammation. So, although they help to alleviate pain, they do it by killing your own defence system. This is one of the reasons why beneficial effect from steroids injection is usually short-living. Important fact to remember as well is that standard dose of steroid shot, for instance 40mg Triamcinolone is ten times (!!!) more that daily dose of steroids naturally produced by our body.

Why steroids are dangerous amid coronavirus pandemic?

Fighting any infection, be it bacteria or virus, requires a huge mobilisation of your body’s own defence system. Your immune system has to fight bacterias and viruses, stop them spreading in your body doing harm. And if you happened to take a steroid shot, you jeopardise your whole immune system. In practice, it means that you put yourself in a risk of loosing the battle with the infection. In case of Covid-19 the risk is deadly…

Many health organisations, such as Faculty of Pain Medicine of the Royal College of Anaesthetists and British Society of Skeletal Radiologists have issued their guidelines where they advise a great caution regarding steroid shots during the pandemic.

Is it safe to have steroid injection after the pandemic?

It is a difficult question. First of all we have to accept that the virus will stay around for a while so the risk of infection will be still very real, at least unless the vaccine is available. The possibility of second wave of pandemic or indeed a new pandemic cannot be reasonably discounted. But also we have to look from broader perspective: what we have learned from the current pandemic is that one needs a strong and robust immune system in order to survive. The lesson is that we should protect our immune system and make it strong by avoiding anything what might jeopardise it, like steroids, and by helping maintaining its integrity and strength, by the way of right supplements, diet, and healthy lifestyle, including exercise, good night sleep and so on.

What are the alternatives for steroids?

The alternative is offered by regenerative medicine. Platelet Rich Plasma (PRP) injection is simple, effective and safe way of dealing with inflammation and pain. How PRP is different from steroids though? First and foremost, PRP stimulates immune response to trauma and inflammation. So it works in oposite way to steroids which suppress immune response. Blood platelets contain a large amount of growth factors and anti-inflammatory factors which directly reduce inflammation at the site of injury. So PRP enhances natural reaction to injury and promotes healing. Secondly, it is your own blood so there is no risk of cross-infection or overdose like it is with any drug.

So if you suffer from joint, spine, ligament, muscle pain and you think or you have been offered steroid injection, think twice before you decide to have it. There are alternatives and we are here to discuss it with you and help you with your pain problem. (ZK)