Metabolic and Endocrine Effects of Repeated Epidural and Sacroiliac Joint Corticosteroid Injections
Metabolic and Endocrine Effects of Repeated Epidural and Sacroiliac Joint Corticosteroid Injections
Corticosteroid injections into the epidural space or sacroiliac joint are increasingly used
 for the treatment of chronic neck, low back, and leg pain. These injections may have several
 side effects, including suppression of the body's adrenal glands to produce steroids (adrenal
 suppression) and negative effects on metabolism (weight gain, increased blood pressure, and
 high blood sugar levels).

 The purpose of this study is to determine the time course and predictors of adrenal
 suppression and the metabolic effects of corticosteroid injections for chronic pain.

 The investigators hypothesize normalization of adrenal function to occur within three weeks
 of injection in most individuals. An increased frequency of injections is predicted to lead
 to prolonged adrenal suppression. Corticosteroid injections are also hypothesized to lead to
 increases in body weight, blood pressure, and blood sugar levels, particularly in diabetic
 individuals.
Interventional pain procedures using corticosteroid injections (CIs), such as epidural
 steroid injections (ESIs) and sacroiliac joint injections (SIJIs), may have adverse metabolic
 and endocrine effects, including suppression of the hypothalamic-pituitary-adrenal axis
 (HPAA), hypertension, weight gain, and hyperglycemia. Based on sparse data on these adverse
 effects following repeated, long-term CIs, current guidelines suggest a maximum frequency of
 four to six injections annually, even though patients may benefit from more frequent
 treatments.

 This prospective cohort study will follow first-time or repeat ESI or SIJI patients receiving
 injections with 0.5 mL bupivacaine 0.25% and 15 mg dexamethasone sodium phosphate at a
 maximum frequency of once every six weeks in order to:

 -  determine the frequency and duration of HPAA suppression;

 -  determine the incidence and predictors of prolonged (≥ 3 weeks) HPAA suppression;

 -  determine the baseline incidence and predictors of HPAA suppression in chronic pain
 patients presenting for their first CI; and

 -  determine the effect of CIs on body weight, resting blood pressure, and glycemic control
 over a six-month period.
Inclusion Criteria:

 -  Patients receiving SI joint or epidural corticosteroid injections

 -  At least 18 years of age

 Exclusion Criteria:

 -  Contraindication to corticosteroid injection (infection; pregnancy; uncontrolled
 diabetes mellitus [per patient's report]; active congestive heart failure;
 coagulopathy; medical conditions that prohibit holding anticoagulant or antiplatelet
 therapy, with the exception of aspirin, for at least two weeks prior to injection; and
 allergy to iodinated contrast dye, corticosteroids, or amide local anesthetics)

 -  Known disorder of the hypothalamic-pituitary-adrenal axis

 -  Corticosteroid injection within 6 weeks of study enrollment