Steroids and Local Anesthetics Kill Cartilage Cells and Mitochondria

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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Steroids and Local Anesthetics Kill Cartilage Cells and Mitochondria
Injured weekend warriors, dedicated athletes, and seniors with aching joints need to be aware of the negative effects of steroid injections and local anesthetics on cartilage health. There is no doubt that many joint pain sufferers experience temporary relief of pain when steroid injections and local anesthetics are used, but at what cost? A number of studies prove that these widely used treatments are actually toxic to the cartilage cells and mitochondria in the joint that is being treated.

If you are facing this situation of steroid injections or the use of local anesthetics to curtail joint pain or have reconstructive surgery, you need to be aware of these findings and have a thorough discussion with your medical provider. This information should be an impetus to add or keep natural mitochondrial and cartilage support at the front-line of your therapy choices.

Steroid Injections and Cartilage


Researchers studied the effect of a one-time dose of a sngle-injection steroid shot on cartilage cells. The scientists evaluated betamethasone sodium phosphate and betamethasone acetate (Celestone Soluspan) which are commonly used steroid drugs for medical joint pain management. They studied the effects of the steroids on chondrocytes/cartilage cells. Results of this study demonstrated that within 14 days after a single injection of the steroids, cartilage cells died.

Steroids Combined with Local Anesthetics


Within orthopedic and pain management practices, the use of local anesthetics, which are different than the corticosteroids, are often used to manage joint pain after orthopedic or arthroscopic joint surgery. The same corticosteroids listed above are often combined with a local anesthetic. Researchers noted that there was very little information in knowing what the combined effects were with local anesthetics and corticosteroids. A study found that when corticosteroids (Celestone Soluspan) were combined with a single injection dose of 1% lidocaine or 0.25% bupivacaine, it caused a pronounced toxic effect to cartilage cells after just two weeks. The authors of the study issued the warning that clinicians should use caution with this combination of injectable pain medications.

The combined steroids and local anesthetics are often used with pain pumps to manage severe pain problems. In cellular studies significantly more cartilage cell death occurred after just 72 hours when epinephrine was combined with bupivacaine. It was recommended that this combination not be used for pain pump use.

Other studies have also looked at local anesthetics for the use of joint pain management and its effect on cartilage cell. Recent research has demonstrated that a mixture of steroids and local anesthetics were horribly toxic to cartilage cells and the joints synovial fluid after just one exposure despite intact cellular make-up. In this study, the compounds used were 1% and 0.5% lidocaine, 0.25% and 0.125% bupivacaine, betamethasone acetate, and methylpresdnisolone acetate. Multiple exposures to injections or pain pumps and at higher concentrations have some researchers significantly frowning on the medical approach and advising caution when these substances are used.

Local Anesthetics for Post-Op or General Pain Management


The initial goal by you and your orthopedist is to provide pain relief for the injured or osteoarthritic joint especially in the context of managing post-operative pain. However the discussion that you have will likely not include one very key finding on this topic of local anesthetics and your cartilage. Researchers have found that when human cartilage cells are exposed to local anesthetics like 2% lidocaine, massive necrosis or cartilage cell death occurs after 24 hours.

It did this by causing damage to the mitochondrial DNA interfering with cellular energy and mitochondrial protein levels. The end result was that mitochondria were damaged and cell death occurred to the cartilage cells. Five days after the exposure to the local anesthetics the destructive process was still evident indicating delayed mitochondrial dysfunction and cartilage cell death. The local anesthetics used were lidocaine, bupivacaine, and ropivacaine. Higher doses of 2% lidocaine, etc were more toxic than 1 or 0.5 percent.

Other research has expanded on this finding and has noted that the condition or health of the cartilage determines how well the cartilage cells can handle the drug exposure. Researchers confirmed what would seem to be common sense. After exposure to the local anesthetics, cartilage cell death rates were worse when the joint had osteoarthritis. When the cartilage was healthy, there was less death and destruction to the cartilage cells as a whole.

This means that the individual most likely to seek this type of care to begin with because of disability and pain and gets this type of treatment will end up in a perpetual cycle. The drug creates temporary numbing of pain, but the mitochondria and cartilage cells breakdown and die at a higher rate had their not been this type of treatment rendered. Recent medical reports on the severe complications related to local anesthetic injections into the joint have raised concerns within the medical profession and now it should for you as the unsuspecting recipient.

As we saw above, one of the fundamental breakdowns within the cartilage cells is the damage to the mitochondria. Protecting the mitochondria from injury is the major point of intervention. When mitochondria are injured, they release damaging free radicals, ROS (reactive oxygen species) and other inflammatory enzymes. This inflammatory cascade injures the cartilage cells and causes the breakdown in the cartilage layer.

If you are faced with the situation of using steroid and local anesthetics because of severe osteoarthritis, or trauma or surgery to a joint, know that there are options. Nutritional support needs to be used as part of your recovery plan to help support healthy healing and protect the cells from the medication-induced trauma as best as possible.

Nutrients to Help Protect Cartilage Cells from Drug Toxicity


Researchers have identified three natural compounds that help protect the cartilage cells and mitochondria against the toxic insult of local anesthetics. Studies have shown that vitamin C is one of those protective compounds. A study published early 2016 found that vitamin C improved chondrocyte health and reduced cell death following exposure to local anesthesia. Vitamin C also reduced inflammatory enzymes and quenched the ROS generated from the damage mitochondria. Research showed that vitamin C protected against the toxic insult of ropivacaine, bupivacaine, and lidocaine.

Hyaluronic acid was also shown to provide significant protection for several hours after the local anesthetic exposure. One study identified that when hyaluronic acid was administered with the local anesthetic bupivacaine, that the cartilage cell toxicity was substantially reduced and ill effects were nearly avoided. Researchers also found that magnesium reduced lidocaine’s toxic effects on cartilage cells.

There is no doubt that appropriate pain management and joint rehabilitation needs to occur when individuals are suffering. As sophisticated as what orthopedic medicine has become, we still need to approach these procedures and treatments carefully and with wisdom. We saw in a few of these studies that it took just hours to a few days to severely destroy mitochondria and cartilage cells after exposure to a single dose of these meds.

When was the last time that you heard your orthopedic doc mention how to protect cartilage cells and mitochondria? Probably never. Less toxic medical approaches combined with natural support must be present to reduce the risk for the adverse consequences. Thankfully, there are numerous other natural compounds that are known to protect cartilage cells and mitochondria. Several nutrients help to reduce oxidative stress and inflammatory stress to these structures. PQQ, omega 3 oils, coenzyme Q10, curcumin, boswellia, vitamin D and K, and several others should be in the tool bag to help protect and support mitochondria and cartilage cells in joints.

No matter what type of orthopedic surgery or pain management procedure, or what joint (hip, knee, shoulder, spine, etc) is affected, if your physician uses steroids and/or local anesthesia described above as part of the treatment, significant risk and side effects can occur. The combination of severe osteoarthritis and toxic drugs provoke further damage to the joint cartilage cells and mitochondria. For the sufferer, the drugs create temporary relief in an already difficult situation. For Big Pharma, it means a steady stream of repeat customers with this treatment approach unless the vicious cycle is aborted by protecting the cartilage cells and mitochondria. Ideally, keep the cartilage as healthy as possible, so if an injury happens, recovery is easy. If you know what to do before, during or after encountering these concerns, it places you more in the driver’s seat of joint health and recovery.

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