Are You Being Overdosed? Rethinking Steroid Injections for Spine Pain
- cassis101
- Apr 19
- 3 min read
Published by Deborah Westergaard, M.D. | Pain Experts | Regenerative Spine and Joint Care in Dallas & Plano
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The Hidden Risk in Traditional Spine Injections
If you’ve had back or leg pain and were told you needed a transforaminal epidural steroid injection (TFESI), you’re not alone. But what you may not know is that many patients are being treated with dangerously high doses of steroids—without realizing the potential long-term consequences.
A recent experience hit close to home. A dear friend of mine developed acute radiculopathy. Care from a local clinic was sought after undergoing a transforaminal epidural steroid, I asked, " How much steroid did they inject?”
The answer: 20 mg of dexamethasone.
Is 20 mg Too Much? Yes—According to Pain Society Guidelines
The American Society of Interventional Pain Physicians (ASIPP) does not support this level of dosing. In fact, most guidelines and practicing specialists recommend no more than 10 mg of dexamethasone, with 4–8 mg being the common range for nerve root level injections.
References:
ASIPP Guidelines – An Algorithmic Approach to ESI
Survey of Pain Physicians – ScienceDirect, 2023
Dosing Efficacy – BMJ RAPM Study
Despite this, many providers still default to “maximum dose” steroid injections, which can:
Suppress your HPA axis
Cause elevated blood sugar, especially in diabetic patients
Disrupt immune and mitochondrial function
Potentially interfere with regenerative treatments if given before PRP or orthobiologic treatments.
Microdosing: A Modern Approach to Nerve-Targeted Therapy
Unlike conventional methods, Pain Experts specializes in microdosing corticosteroids, often below the traditional threshold, to achieve a localized anti-inflammatory effect without systemic suppression.
This isn’t just opinion—it’s backed by research.
A foundational study by Zhang et al. in a rat model of spinal nerve ligation showed that dexamethasone reduced proinflammatory cytokines, nerve pain behaviors, and abnormal nerve sprouting—even at modest doses. (PMC Article)
This reinforces the idea that targeted, low-dose delivery near neural structures may be not only sufficient—but strategically superior for recovery.
For High-Performing Professionals, Downtime Is Not an Option
If you're a high-functioning individual balancing leadership, fitness, travel, and family life, traditional high-dose steroid injections may compromise more than they correct. These outdated methods were never designed for those who need rapid, lasting results with minimal disruption to performance.
At Pain Experts, our philosophy is built for those who:
Can’t afford setbacks
Expect elite-level medical care
Want long-term spine health without sacrificing cellular or metabolic integrity
What We Offer at Pain Experts
Our regenerative spine protocols include:
Microdosed epidural injections unde
r image guidance
Platelet-rich plasma (PRP) and bone marrow aspirate therapy for disc and joint pain
Ultrasound-guided nerve hydrodissection using regenerative solutions
A concierge-level patient experience with locations in Dallas and Plano, Texas
Built for Leaders Who Need Results Without Compromise
If you've been given high-dose epidural injections and are still in pain—or are searching for a smarter approach to avoid surgery—Pain Experts offers the next generation of spine care.
Schedule your consultation today and experience a practice that respects your time, performance, and long-term well-being.
Click here to schedule a regenerative consultation with me at Pain Experts.
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Dallas epidural steroid injection
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