Stemcelldoc's Weblog

January 13, 2009

Cortisone Injections Flare

Cortisone injections are used routinely  by orthopedic surgeons, rheumatologists, family practice and pain management physicians.  The goal of cortisone injections is to decrease the inflammation in the affected area.  Pain physicians often use cortisone injections for sciatica in which a disc bulge is causing compression on a nerve root resulting in severe burning leg pain. 



Cortisone is a steroid and is available in different brands and concentrations.  Some  examples include Depomedrol, Celestone and Solu-Cortef.

Cortisone injections flares typically occur due to the amount of steroid  injected and the size of the needle used.  Typical concentrations injected by physicians  are 4-6mgs.  A milligram is one thousandth of a gram.  This dose represents  100,000 to 1,000,000 times more than your body naturally uses to control swelling. These large concentration of cortisone  are  associated with adverse effects including flares.  Other common side effects include swelling, itching, weight gain, compromise of the immune and renal function as well as potential deterioration of the affected joint.  Unlike most practices, the Centeno-Schultz Clinic  uses very low dose steroids ( nanograms) which are compounded exclusively for our clinic. 

The other issue associated with cortisone injection flares is the needle size.  Most physicians use a 20 gauge needle.  At the Centeno-Schultz Clinic we use a 25 or 27 gauge needle so as to reduce the incidence of cortisone injection flares.

Alternative to steroids include prolotherapy and the use of stem cells to reduce inflammation, repair damaged tissue and provide long term pain relief.


January 11, 2009

Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections are a common therapy for patients with lower back and leg pain as  a result of a disc bulge or herniation.   If the disc is bulging or herniated it can compress the nerve root causing leg pain and or weakness.

The epidural space is a area around the spinal cord and is adjacent to the disc.


Injection into this space allows medication to bathe the irritated nerve root and disc.   One can think of an epidural steroid injection as putting water on a large fire.  At the Centeno-Schultz Clinic all epidural steroid injections are performed under x-ray to ensure accurate placement of medication.  Unlike other clinics,  we do not use the conventional high concentrations of steroids.  For example most epidural steroid injections use  4 or more milligrams of steroids.  At the Centeno-Schultz Clinic we use only nano-grams concentrations because it is closer to the dose that the body uses naturally.  It also avoids the adverse effects of steroids which include suppression of immune and renal function, itching, increase in epidural fat, deterioration of the outer annuls of the disc, insomnia and weight gain.  If steroid therapy is not effective or not attractive to the patient,  through Regenexx we have the ability to inject natural growth factors  such as platelet lysate of VEGF supernatant into the epidural space.  These factors not only provide an anti-inflammatory effect for the irritated nerve and disc but they also promote increased blood blow to the disc and therefore healing.

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