What are Cortisone / Corticosteroids Injections?

As a pain management physician, one of the most powerful tools in my arsenal against pain is a steroid injection, also known as a “cortisone injection” or “corticosteroid injection”. Cortisone is a powerful anti-inflammatory medication that reduces the inflammatory response of many painful conditions including arthritis, tendinitis, bursitis, and sciatica, to name a few. For the treatment of numerous painful spine conditions, one of the most successful and potent treatments is an epidural steroid injection.

To remember: One of the most common misconceptions about corticosteroid shots among patients is that they think that Cortisone is a pain relieving medication. Cortisone is an anti-inflammatory medication. After a cortisone injection, the pain decreases due to the reducing inflammation.

What are Cortisone Injections used for?

Since cortisone injections are powerful anti-inflammatory medications, they can be used as Local Cortisone Injections to reduce the inflammation of small areas of the body or as Systemic Cortisone Injections to reduce widespread inflammation of the body. Below in this post, we’ll also discuss about the side effects of both local and systemic steroid shots.

Local cortisone injections can help with bursitis, tendinitis, and with joints (arthritis). As a matter of fact, steroid injections are a frequently used to treat joint inflammation for many arthritic patients. Treatment is not the only reason why cortisone injections are used. When used with anesthetics such as lidocaine, it can help to confirm a diagnosis.

Systemic cortisone injections, which are usually given intramuscularly (gluteus or deltoid muscles), are used for conditions that affect the skin or many joints at the same time such as rheumatoid arthritis, allergic reactions and asthma. In order to treat even more severe conditions, this injections can be administered intravenously.

Cortisone Injections Common Questions

Some patients are concerned about the use of cortisone in their body.  The most common questions they ask about the use of this type of steroid injection help us to conclude that is a great level of concern about the use of cortisone shots and if they are indeed bad for one’ body:

  • Isn’t cortisone unnatural?
  • Won’t cortisone injections harm my bones and cartilage?
  • Will cortisone shots cause my tendons to rupture?
  • Aren’t cortisone injections painful?
  • Are corticosteroids the same as cortisone?
  • If I already received a previous cortisone injection and it didn’t work, why will this one be different?
  • What are the side effects of cortisone injection and the possible reaction to a cortisone shot?

In response, cortisol is a potent hormone called glucocorticoid that is produced naturally by the body. Along with adrenaline, cortisone is one of the two main hormones released by the adrenal gland in response to stress.  Cortisone suppresses the immune system, thus reducing inflammation and its corresponding pain and swelling at the site of an injury.

Anti-inflammatory medications can be taken orally, but this distributes the medication in very diluted dosages throughout the entire body.  A steroid injection, on the other hand, places a concentrated dose of medication directly at the site of the injury and the source of the pain, making it a very potent treatment.

To clarify about the nature of corticosteroids, it refers to a class of cortisone related medications known for reducing inflammation. Cortisone is a common type of corticosteroid, thus explaining why most people or healthcare professionals used both terms interchangeably.

Cortisone injections are very safe to perform and should always be performed by a properly trained and experienced physician or other health care professional.  With the advancement and availability of modern imaging technology including mobile ultrasound and fluoroscopy, it is recommended that most injections be performed under direct image guidance to maximize both the efficacy and safety of the injection.

Please find below some of the most common known cortiscoteroids injections pros and cons so you can be able to determine if it is a viable option for you. When a physician recommends a treatment – including steroid injections -, it is not based only on the condition itself, but on the patient’s personal goals and predisposition as well since every patient is different.

Regarding a patient reaction to a cortisone shot as well as its possible side effects, please keep reading below to further understand them.

Cortisone Shots Pros

Some of the well known cortisone injections advantages:

  • Cortisone is a naturally occurring substance
  • Cortisone injections are easy to administer and well tolerated
  • Cortisone injections have few side effects
  • Side effects of cortisone injections tend to be minor and rare

Cortisone Shots Cons

Side effects of cortisone injections tend to be rare and minor.  However, they do exist and potential patients tends to wonder the most about the potential side effects of a cortisone shot prior to deciding on moving forward to it.

Cortisone Injection Side Effects

Then again, this is one of the main concerns of a patient when it comes to the procedure.  To better understand the possible side effects of a cortisone injection as well as a patient’s possible reaction to a cortisone shot, we divided them based on the body targeted areas by local side effects and systemic side effects.  Potential side effects of a cortisone shot include the following:

1. Local Side Effects

  • Some people experience local discomfort after an injection and may have an increase in pain for 24-48 hours post-injection. This is called a “cortisone flare” and usually subsides quickly.
  • Whenever there is a break in the skin, as in during an injection, there is a risk of infection. The doctor should always sterilize the skin to minimize the risk of infection and use gloves.
  • High doses of cortisone may have detrimental effects on joint cartilage and tendons.
  • In older patients with worn-out or damaged joints and tendons, the concern is much less. Caution should generally be exercised in young, healthy individuals with otherwise pristine joints.
  • Cortisone may also weaken tendons; therefore many doctors will use tendon-specific cortisone injections sparingly, especially the achilles tendon which is particularly prone to rupture with repeat injections.

2. Systemic Side Effects

Although steroid injections are a local, targeted treatment, a small amount of the steroid may be absorbed into the bloodstream and distributed throughout the body. And since the body actually produces cortisone naturally, most people do not experience systemic side effects from cortisone injections.

  • The most common systemic reaction is seen in diabetic patients an a temporarily elevated blood sugar. Diabetic patients, especially those taking insulin, should monitor their blood sugar after an injection and adjust their insulin dose if necessary.
  • Patients may experience facial flushing and redness after an injection. This reaction can begin within a few hours after an injection and may last for a few days. It is more common in women.

In summary, cortisone injections are extremely safe and effective treatments, but still do carry potential problems, most all of which are minor and rare. As with most other medical treatments, the key to the success of a cortisone injection is a properly chosen patient candidate and condition, paired with an experienced and skilled doctor. If you have questions or concerns about having a cortisone injection, speak with your doctor.