Most things in life have
trade-offs. While I don’t want to be perceived as slamming the medical
profession, the fact remains that medical care has some of the biggest
trade-offs in the world, but many times they aren’t pointed out to us.
Cortisone shots can seem to
provide miraculous healing, but the trade-offs are rarely mentioned. Sometimes
the trade-offs are worth the risks, but THE PATIENTS should be the ones making
the decision, not the doctors. Most medical providers appear to start with the
premise that the effects of drugs and surgery are so inconsequential that they
are ALWAYS worth the risks.
The first thing that you
probably have not been told about cortisone is that the body builds a tolerance
to it. Every time you are exposed to cortisone, it is less likely that your
body will mount the hoped-for response of decreased inflammation and pain. It
appears that the 50% rule applies: 50% of the people will have no response the
first time they receive an injection, of the ones who did, 50% will have no
response the second time, and so on. We are able to purchase cortisone creams
over the counter, and this exposure alone may be sufficient to trigger the
tolerance and the body’s resistance to even the first injection.
The importance of this
information is that if you have only one or two chances to enjoy a major
decrease in pain, you might prefer to save them for a time when you believe
there is no other solution. Studies show that when people are told of the risks
of painkillers and then allowed to determine their own schedule for receiving
them, the necessity for the painkillers is markedly reduced. Many times our
pains are not as bad as we first thought.
The second item you may not
have heard about is that repeated cortisone exposure causes joint surface
deterioration and tendon ruptures. The very joints that we are treating
experience a more rapid erosion of the joint surfaces, and tendons in the area
become weakened, with an increased likelihood for ruptures and tears, resulting
in circumstances worse than those for which we were injected. Interestingly,
since cortisone also causes atrophy or loss of the fat pads, someone being
injected for plantar fasciitis may actually experience MORE pain when walking
due to the decreased cushion.
Thirdly, Prednisone, the
long-term version of cortisone, usually in pill form, often causes dramatic
weight-gain, generally uncontrollable by standard means.
I recognize that none of
these are absolute, and that life-threatening circumstances, or unbearable pain
must be alleviated whenever possible. But, all of this knowledge should be
shared, and then the patient allowed to make an informed decision regarding the
risks he is willing to take.
Cortisone is only one example
of the trade-offs made under medical care. In the next post I will talk about a
common trade-off that is made under chiropractic care.
Getting rid of your pain,
Dr. Steven Ray, Chiropractor
Val Vista Chiropractic
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