Q&A: What are the Pros and Cons of Cortisone Injections?

Man with inflamed shoulder pain - Is cortisone a solutionIf you have a chronic painful condition and you are considering cortisone injections, you need to balance the risks of this procedure against the benefits. Sometimes two people with the exact same condition will decide on two different courses of treatment. The key is to find out what is right for you. Here is some information that I hope will help you make that decision.

Cortisone is a steroid. Injections help to reduce inflammation and, in so doing, also can dramatically reduce pain. Cortisone also has many other medical applications. Dermatologists, for example, use it to treat certain skin conditions and to reduce inflammation. (I do want to clarify that cortisone used for injections is a synthetic substance, and it is not the same type of drug as performance-enhancing steroids.

While cortisone injections can offer substantial pain relief to some people, cortisone is not actually a pain reliever. Cortisone works because it reduces swelling and inflammation, which are major contributors to some painful conditions.

Another advantage of cortisone injections is that the anti-inflammatory agent is administered directly to the spot where it is needed. This means that the drug’s effect is limited to a specific area and you avoid having your entire system exposed to a high concentration of the drug.

Cortisone injections can treat bursitis, many types of arthritis pain (including rheumatoid arthritis pain), tendinitis, tennis elbow, frozen shoulder, carpal tunnel syndrome, and other musculoskeletal conditions.

Cortisone is associated with a number of side effects. Not all—not even most—people will experience side effects, but they are always a risk.

Cortisone may cause or worsen diabetes, insulin resistance, pre-diabetes, and hyperglycemia. In other words, cortisone can play havoc with your blood sugar. If that is a problem for you already, this could be a side effect you do not want to risk.

A rare but very serious side effect is called osteonecrosis or “bone death.” Most cortisone shots are given into or near a bony structure. The cortisone can cause some of that bone tissue to die. Cortisone may also result in a thinning of the bone (osteoporosis). Cartilage within the joint may be damaged from cortisone, particularly if you have many shots over your lifetime. Additionally, cortisone shots can damage the joint itself or nearby nerves, and some patients report discoloration (usually lightening) of the injection site area.

Other side effects associated with cortisone include anxiety, depression, cataracts, and glaucoma. In women, cortisone may disrupt their monthly cycles.

Although cortisone shots are administered to reduce pain, they sometimes have a paradoxical effect and temporarily worsen pain and inflammation. This usually goes away in about 48 hours; doctors call this sudden, sharp (but short-lived) increase in pain a “flare.”

Finally, the injection itself may be painful, and some people feel an overall warmth or redness in the face and chest after a shot. If it helps you, you can apply ice to the injection site to help minimize the discomfort. Sometimes the physician will give you a shot of numbing medicine (or coat the injection site with a topical anesthetic) before going forward with the cortisone injection.

Some Other Considerations With Cortisone

Because cortisone has many side effects, some potentially serious, most physicians will limit how many shots you can receive in a year. In other words, this treatment is a good short-term solution for pain, but you cannot rely on it to manage your pain all of the time.

If you take blood thinners (such as warfarin) or dietary supplements that thin the blood, you may need to discontinue them for a few days before a cortisone injection, because the injection may otherwise result in extensive bruising. If you are going to get a cortisone injection, tell the doctor the name of all of the medications you are currently taking, including over-the-counter products, vitamins, and dietary supplements. Once you get your cortisone injection, you can usually resume taking these products.

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