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General Medical Questions
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Question : I fell during skating last year. Since then, I have daily low back pain. I was offered a steroid shot at the ER, but declined it. Should I have gotten the shot? Is this something I should ask for now?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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January 06, 2012
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A:

I’d like to answer your questions. But some more information would help.

For example:

  • Did you have back pain before your fall?
  • How severe is your pain?
  • Where is the pain? Does it spread down one or both legs?
  • Does your pain interfere with your ability to function normally?
  • Was your physical exam normal?
  • Did you have x-rays to rule out a fracture?

Or do you have a history of:

  • Major trauma
  • Severe, unrelenting or worsening pain
  • Fever
  • Unintentional weight loss
  • Cancer
  • Use or abuse of certain drugs (such as long-term steroids or intravenous recreational drugs)

The most common causes of chronic low back pain depend on your age. With younger people, it’s muscle spasm and strain. With the elderly, it’s more likely to be arthritis, disc disease, fractures from osteoporosis and spinal stenosis (narrowing of the space where the spinal cord and nerves travel). Middle-aged people may have back pain from any of these conditions. Other causes, both rarer and more dangerous, can include infection and tumors. For a majority of people with back pain, no specific cause can be found.

The role of cortisone (steroid) injections for back pain is controversial. They are commonly offered for certain conditions when other, more conservative treatments fail. For example, if your pain is due to spinal stenosis and you don’t get much relief from pain relievers and physical therapy, a cortisone injection may be a reasonable next step. However, studies are mixed on whether they reliably work.

Doctors don’t normally offer cortisone shots as a first treatment just after a fall. And there’s no evidence that getting one after an injury will lower the chances of long-lasting back pain in the future.

Should you ask for a cortisone injection now? That depends on the cause of your pain and what treatments you’ve already tried. When a cause can be identified, it can usually be diagnosed by a detailed review of your symptoms, medical history, physical examination and, in some cases, imaging studies. X-rays and MRI scans tend to be the most useful imaging tests but they’re not required in all cases.

Talk to your doctor about the cause of your back pain and what the best next steps are in evaluation and treatment.

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