I am right there with you on waking up in the middle of the night from breakthrough pain. When I used to see my PMD, he prescribed lortab for use during the day and zanaflex for back muscle spasms at night. I can't praise this med enough...I sleep through the night (it knocks me out!) and I don't have any pain...until once I'm up the next morning, of course. Zanaflex and Soma (either one) have been lifesavers for my nighttime muscle pain. Have you tried either of these? As for the steroid shots, I have never had these, but I have had epidural injections (6 altogether) and they were worthless to me. The injected area was numb for about 2-3 days and then worse than ever after that. I have heard mixed reviews on here about these types of injections. I think it just depends on your injury. Mine is a bulging disc and I have nerve damage in the surrounding areas. My PMD was absolutely confident that he would alleviate all of my pain (that is how they get you coming back to shell out the big bucks on these treatments...and the doctor said that they were cumulative, so that I held onto hope). The only thing that my PMD did to help my pain was to prescribe narcotic pain meds. I wish I would have saved my money and found OP's sooner. Oh well! Live and learn!