Yes, Multiple Non-Steroidal Pain Injection Options Are Available
Several pain injection options exist that do not contain steroids, including local anesthetic-only injections, NSAID injections (such as ketorolac), platelet-rich plasma (PRP), and hyaluronic acid injections.
Local Anesthetic-Only Injections
The most established non-steroid option is local anesthetic (lidocaine) alone for epidural and other spinal injections. A 2020 systematic review and meta-analysis demonstrated Level II (moderate) evidence that epidural injections with lidocaine alone provide equivalent pain relief and functional improvement compared to lidocaine combined with steroids for managing spinal pain from disc herniation, spinal stenosis, discogenic pain, and post-surgery syndrome 1. This is particularly important given that the most recent 2025 BMJ guidelines found only moderate certainty evidence that epidural injections with local anesthetic and steroids "probably have little to no effect on pain relief" compared to sham procedures 2.
For trigger point injections specifically, the 2021 American College of Occupational and Environmental Medicine guidelines explicitly recommend local anesthetic alone and state that "glucocorticosteroids are not recommended for use in trigger point injections" 2.
NSAID Injections
NSAID injections, particularly ketorolac, represent an increasingly validated alternative to corticosteroids for joint and soft tissue pain:
A 2026 study on ultrasound-guided hip injections found that ketorolac provided significantly greater pain relief than corticosteroids (dexamethasone) with similar duration of action for osteoarthritis, femoroacetabular impingement syndrome, and extra-articular tendinopathy 3
A 2024 systematic review with meta-analysis comparing NSAID to steroid injections for shoulder impingement syndrome and knee osteoarthritis found no significant difference in pain scores at 1 month and 3 months, suggesting NSAIDs are equally effective 4
A 2018 systematic review concluded that NSAIDs provide "equivalent, if not better, pain relief" compared to corticosteroids, with weak evidence supporting lower symptom recurrence rates 5
Regenerative Medicine Options
Platelet-rich plasma (PRP) has emerged as an autologous alternative, particularly for chronic joint pain from osteoarthritis. A 2026 review found that while corticosteroids provide superior short-term relief, PRP offers more sustained medium and long-term pain relief and functional improvements 6. However, PRP is typically not covered by insurance and requires out-of-pocket expense 7.
Hyaluronic acid injections may offer pain relief with a potentially lower risk profile compared to corticosteroids, though they also face insurance coverage limitations 7.
Clinical Decision-Making Algorithm
When selecting a non-steroid injection:
For spinal/epidural injections: Use local anesthetic (lidocaine) alone—evidence shows equivalence to steroid combinations 1
For trigger points: Use local anesthetic only; avoid steroids per guidelines 2
For joint injections (knee, hip, shoulder):
Important Caveats
The 2025 BMJ guidelines recommend AGAINST most interventional procedures for chronic spine pain outside of clinical trials, finding moderate to high certainty evidence of little to no benefit compared to sham procedures 2. This applies to both steroid and non-steroid formulations for epidural injections.
Ultrasound guidance improves accuracy and safety for all injection types and should be utilized when available 7.
The variability in PRP preparation methods (single vs. double-spin, leukocyte concentration, platelet concentration) limits consistency across studies, making standardized protocols still necessary 6.