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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.

Click Below to schedule your new patient appointment:


  • Dallas epidural steroid injection

  • Plano regenerative spine treatment

  • BackpainPlano

  • Non-surgical back pain relief

  • PRP for back pain

  • Microdosing steroids

  • BackpainDallas

  • Concierge spine care

  • Orthobiologics for radiculopathy

 
 
 

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               Deborah Westergaard, MD

Pain Experts

9301 N Central EXPY STE 115 Dallas TX 75231

1400 Preston Road STE 120 Plano, TX 75093

Phone 214 750-6200

Fax 214 750-6203

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