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Inject steroids, lose a hip

 •  • by Paul Ingraham
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This is a rather eye-catching summary for a paper:

Screenshot of NEJM Journal Watch summary with highlighted text: "These injections were associated with excess risk for rapid hip destruction.

The study (Okike et al) identified a low risk of “rapid hip destruction disease” with one low-dose steroid injection, and “higher” risk with larger and multiple injections.

This is hardly the only evidence of harm from steroid injections — rupture of ligaments is another alarming one — but I think this is the most dramatic I have ever seen. RHDD is what it sounds like: premature and accelerated arthritis. Best avoided!

Seriously, folks, do not inject steroids into anything unless enduring your pain is worse than a remote but real risk of destroying a joint. This doesn’t mean that steroids are never worth it, of course. We’re always weighing the risks against the benefits in medicine — but you need to know the risks to weigh them. This risk is remote, but also as serious as an amputation.

I have asked for a steroid injection just once in my life, during a flare-up of calcific tendinitis of the shoulder, for pain like a rotting tooth that kept me awake and nauseous for days. I asked a GP for an injection, completely confident that it was worth the risk, but my request was denied. I hear about steroid overprescription constantly, but I found that rare cautious doctor!

When I recovered, pain amnesia set in, and I now side with the doctor — not even a one wee squirt of the stuff was worth it, not even to save three nights of sleep (which wasn’t a guaranteed result). It was a horrible ordeal, but it was temporary. I will now consider injecting steroids only for severe and chronic pain.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher