The Truth About Steroids for Pain Relief

Available for Interviews: Dr. Tammy Penhollow

Dr. Tammy Penhollow is a Doctor of Osteopathic Medicine, specializing in anesthesiology, pain management, and regenerative medicine. Having over 20 years of experience has helped her to cultivate a passion for regenerative medicine and holistic healing. Dr. Penhollow practices at Precision Regenerative Medicine in the greater Phoenix area.

What Dr. Tammy Penhollow can say
in an interview on Steroids for Pain Relief
:

Do you remember the “old days” when your GP would give you a “steroid shot” in the arm or hip once or a couple of times a year to help “with the arthritis” or whatever malady you may have presented with? Are you an athlete who was returned to play over and over again with a shot of corticosteroid to control the inflammation of an acute injury? 

Or are you a person who’s trying to avoid that knee/hip/disc replacement or spinal fusion surgery, so you regularly schedule injections at your pain clinic or your orthopedic surgeon office and get steroid shots into the joints or the spine?

Steroids have their place in certain situations, however, it is not in my preferred treatment algorithm for pain management. What is very important to note is that before EVERY procedure or with EVERY prescription for steroids, proper patient consent for the use of steroids is crucial, and that together the patient and their healthcare practitioner decide if the benefits outweigh the risks. 

      • Steroids in these scenarios are “corticosteroids” a group of hormones that are often used for inflammation, to replace low levels of our own corticosteroids, and to suppress the immune system (such as in rheumatoid arthritis and some forms of cancer).  These are not anabolic steroids such as testosterone which are used to enhance performance and cause muscle growth.
      • Corticosteroids come in inhaled, oral, topical and injectable forms
      • Most patients do not know there is a maximum recommended dose per 12 months of injectable steroids in order to decrease the risk of significant side effects; nor do they know that if they take other forms of steroids (oral >>>> inhaled >> topical) that their risk of side effects is magnified.
      • Even staying under that theoretical “maximum” dose per 12 months does not guarantee the reduction or presence of significant side effects. Some experts agree that the superhuman doses injected or given in oral steroid packs are thousands or tens of thousands of times higher than the body’s own corticosteroid secretion and that only near homeopathic doses would be “safe.”  
      • There are Major side effects of steroid use* 
      • If benefits do NOT outweigh risks, alternative therapies for musculoskeletal pain exist**

As people start to venture out and return to their physicians to address the chronic pains they had to postpone treatment or surgeries for, now is an important time to assess whether or not steroids should even be in the treatment algorithm. Its risks outweigh benefits and there is NOT a way to avoid the risks completely without avoiding steroids completely. We have very feasible alternatives that are not destructive to the body and we have more physicians trained in and practicing this holistic and regenerative approach to chronic pain. 

 

Interviews: Dr. Tammy Penhollow

Dr. Tammy Penhollow practices at Precision Regenerative Medicine in Scottsdale, Arizona, where develops individualized treatment plans for musculoskeletal and spine interventions with PRP and bone marrow aspirate using image guidance, as well as micro-needling with PRP for skin, hair and anti-aging conditions. She also stays active in teaching as an Instructor in Anesthesiology for the Mayo Clinic College of Medicine and Science and as a Supplemental Consultant for the Department of Anesthesiology & Perioperative Medicine at the Mayo Clinic in Phoenix.

A former active duty US Naval Officer, Dr. Penhollow has lived, practiced, and has been deployed around the US and overseas. She embodies the lifestyle she recommends to her patients and is an active hiker, gardener and yogi as well as a French trained home chef and an aspiring sommelier.

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*Major side effects of steroid use:

    • Increased risk of infection/suppression of the immune system (very important in the COVID-19 era)
    • Impaired ability to manage blood glucose (particularly in diabetic patients and those on insulin may need to greatly increase their doses
    • Decreased bone density/osteoporosis (patients with or at risk for osteoporosis are thought to be at increased risk of vertebral compression fracture with additional steroid)
    • Avascular necrosis (lack of blood flow to a joint, most commonly the hip joint, leading to fracture requiring hip replacement.  Intraarticular -in the joint – hip steroid injections may be particularly risky for avascular necrosis of that same joint because of the local vascular uptake).
    • Increased risk of infection of a replacement joint, increased risk of NEEDING a replacement joint:  Intra-articular (knee joint) injections in the 3 months leading up to a knee replacement increase the risk for infection in the new joint.  Infection in a replaced joint is a major complication and may result in the removal of the hardware. A recent 3800 patient observational study showed that patients who received intra-articular knee steroids are associated with a risk of future total knee arthroplasty (joint replacement).  When we tell patients we can give them a steroid to help “buy time” before their joint replacement, we may actually be accelerating the need for the replacement, at least in the knee. 
    • Muscle atrophy: steroid injected into muscles can weaken the muscles and can cause “steroid atrophy” of the muscle and if delivered too close to the surface, atrophy of the skin as well.  This weakens, not strengthens the body.

**Alternative therapies for musculoskeletal pain include:

    • Platelet Rich Plasma (PRP) or Bone Marrow Aspirate Concentrate (BMAC) can effect reduction in inflammation and assist the body in healing the painful spine, joint or soft tissues.
    • topical or oral nonsteroidal antiinflammatory medications to reduce the inflammation and reduce pain
    • Adopting  an anti-inflammatory diet’
    • adjunctive physical, chiropractic, massage and acupuncture therapy can be used.  
    • Addressing weight loss, and gait analysis, using medical equipment bracing as indicated, and focusing on core stabilization

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