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”. 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.

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 cortisone injections 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?
  • If I already received a previous cortisone injection and it didn’t work, why will this one be different?

In response, cortisone 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.

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.

Cortisone Shots Pros

  • 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. Potential side effects include the following:

Cortisone Injection 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.

Steroid Injections 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.