Pros & Cons: Cortisone Injections

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Health Care 2009Cortisone shots are given as symptomatic treatment for a wide variety of repetitive stress injuries, arthritis, and other ailments. Commonly the injection consists of a mixture of a corticosteroid anti-inflammatory and a local anesthetic to minimize pain from the injected medicine.

Most cortisone injections are conducted in a doctor office and may take as little as a 10 minute visit. The site of injection is cleaned and may be sprayed with a local anesthetic. Then the needle is inserted directly into the painfully inflamed joint for medicine delivery.

After receiving the shot, one might be advised to minimize use of the joint for 24-48 hours. For example, in the case of a shoulder injection immediate heavy lifting should be avoided. Sometimes a cortisone flare occurs when the cortisone crystallizes which can cause intense pain for up to 48 hours even worse than before the shot.

While rare, severe side effects such as joint infection, nerve damage, and weakening of nearby tendons and bones are possible. More shots increase the risk of severe side effects so many doctors limit the number of injections to three or less. Since cortisone shots offer pain relief for only several weeks and work for only about half of those receiving a shot, they should be considered a treatment aid at best, not a cure.

One approach to avoid using cortisone injections is to systemically minimize inflammation in the body and focus on treating underlying causes of pain and inflammation. That’s one reason cortisone shots don’t work for everyone – sometimes they are attempting to treat the wrong kind of pain.

There are two types of pain, muscular or tissue based pain and nerve based pain. Treating the wrong type of pain may result in no impact on levels of pain. That’s why a proper diagnosis of the underlying conditions leading to inflammation is critical for long-term pain relief.

Pros for cortisone injections:

  • Can reduce inflammation in localized areas
  • May relieve pain related to inflammation
  • May be helpful as part of a broader treatment program

Cons for cortisone injections:

  • Provides pain relief for only about half of shot recipients
  • May cause more pain in short term
  • Can cause severe permanent side effects
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Comments

  1. Brian Stowe says

    I have had deteriorating right thumb base joint for over a year, and am waiting for a third injection. Meanwhile my left thumb is also affected.
    My surgeon would like to take out a part of the joint, and replace it with other wrist material.
    But it appears that I wil lose gripping power – which makes me delay any such treatment.
    Please is there no other alternative ?
    Thank you.
    Brian Stowe

  2. JANTI RAMJI says

    SOME MONTHS AGO I HAD SEVERE PAIN IN MY LOWER BACK AND HAD TO GO A & E AT THE LOCAL HOSP, THEY TOOK XRAYS AND COULDN’T FIND ANYTHING BUT AFTER MORE INVESTIGATION AND C.T. SCANS OVER THE NEXT FEW WEEKS DOCTORS DISCOVERED I HAD A PROLAPSED DISC AND IT HAS BEEN CAUSING ME PAIN FOR MONTHS NOW, FINALLY I DECIDED TO GO WITH A C.T.GUIDED INJECTION INTO MY BACK BUT EVEN A WEEK LATER IT HADN’T STARTED TO WORK.I HAVE BEEN ON PAIN KILLERS TO NUMB THE PAIN.NOW TWO WEEKS LATER THE PAIN IS NOT AS SHARP AS IT USED TO BE MAYBE THE INJECTION DID WORK BUT I AM STILL TAKING THE PAIN KILLERS BECAUSE USUALLY HALF WAY THROUGH THE DAY IT STARTS TO GET PAINFUL AGAIN.

  3. Carol L Lenger says

    Brian,
    If it is basal joint arthritis, I have had the surgery. It comes with a fairly long recovery period, but I’m so glad I did it. I was losing grip power w/o the surgery, and after surg and hand therapy, I am much better. I wish I hadn’t put it off so long.

  4. shorty4062 says

    I’ve had lower back pain for years. Nothing as worked. I started with therapy, had electronic stimulation, did the epidural injections, saw a chiropractor. All procedures seem to give temporary help. The injections made me blow up like a balloon. I gained weight really quickly. So much weight that I felt like my stomach was growing. I went as far as having liposuction (which turned out bad, I was scarred) except for the medication used after the surgery. Whatever that medication was, it worked. It took a year to recover fully. Once I was off the medication, the pain came back. My L-5 is almost bone to bone. I wear a high wasted body brief that gives some support. I try walking 2 miles, 3 days a week, but must recover from the pain two days a week. I work out using weights also on those two off days or when I don’t feel like walking. I also cut the grass once a week, but also have to recover from the pain. All of this and I’m still over weight. I just had a birthday (turned 58) and feel like I’m 80. I take Celebrex because it’s the only thing that helps somewhat. I don’t look my age and want to enjoy getting out more like I used to.

  5. Marilena Paolucci says

    To those of you with osteoarthritis symptoms such as worn-out cartaledge. Have you looked into prolotherapy?

    Google it and you’ll find a practitioner in your local area.

  6. anna says

    I’ve had severe upper neck pain due to whiplash and being a hair stylist thru the years,so for the first time I had the cortisone injections and at first it was very painful but after about a week I hardly had any pain at all.I wasn’t sure if I was imagining it because I would have pain daily,I couldn’t remember what it was like to not have any.My pain was more tissue damage,so that’s why I think it worked.It still hurt a little,but not as much,it was like putting a band-aid on a raw open wound.We shall see how it long it lasts,but I highly recommend it,cuz if your gonna take pain meds your just covering up the pain as is with this,only temporary relief,but probally healthier?

  7. Henry J Dudley III says

    Prolotherapy is a scam and any Dr. that practices it is a con. It does absolutely nothing for you. All it is is dextrose (sugar water) injected into the inflamed or damaged tendon close to the bone hoping that that would stimulate bllod flow to the area. It’s a scam and any Dr that is doing it should be dis-barred…

  8. teresa says

    i was treated for enthesitis via cortisone inj. in April2009. it didnt last long. in Aug/09 i herniated discl5-s1. Now my back is still in alot of pain( daily)! and i may be awaiting surgery to correct it. If you can do anything for yourself to help the pain, i would suggest doing it instead of getting the shot(s) bacause it only MASKS your injury.It IS NOT A CURE!if anything, it delays the true healing process.. get a second opinion if anyone suggests it to you, there may b other options!

  9. tracy says

    I had a severe injury to my L5/S1. Had physical therapy, epidurals, even pain meds. Gave me no relief. Corrective surgery,walking and a diet of fruits and veggies..helped me recover. I happy to say I live pain free.

  10. antonio D says

    I have a herniated disc , My neurosurgeon Says I have 2 options a cortisone shot or surgery. A friend of mine that has had the same problem says not to get the surgery unless im dying, and another friend that has had the same problem says not to get the shot or surgery. Any suggestions or thoughts.?

  11. D-nice says

    I would recommend the shot, but with that being said make sure you do a pre interview with the doctor who has will be administering it. I had a fracture of my l-5 and my s-1 is bulging. The first doctor who did the injection was not the best. It was done in a operating room at the local hospital. I started to question it all together when every nurse on the floor asked me if I would like the sedatitive. I refused because I don’t care for them. So anyways the shot gets done and I’m moved to a observation room and released 20 minutes later. All was good the first day but after that it was brutal. The pain was so intense that I had to call a friend over to get me out of bed and to the ER. Come to find out that the area the injection was intended to reach was missed and the steroid was agervating the spinal tissue. They gave me a take home pack of 6 Percocet and sent a email to the doctor who administered it. I called all next day and on and on. And never got a return call from her. I called my regular doctor got him a copy of the ER report and he gave me enough pain meds and set up a referral with another specialist. Dr. Verst is a well known spine surgeon here and he gave me 2 options. Try again with the shots or surgery. I was 100% dead set on surgery and was set up with a pain management doctor in a town a hour or so away. I met this doctor (Dr Dille) and he reviewed my charts and all 4 of the MRI images I’ve had this year. We talked about my job and activities I do outside of work and what medicines I’ve taken and how they helped or hindered my pain. I was very relaxed and impressed with him. We were finishing up and he asked why I chose surgery. I explained it in full detail and he was very unimpressed to say the least. We set up our next appointment and as I went to leave I asked him, with what you have seen is it the right choice to have surgery. He declined to give me a direct yes or no but did present a lot of facts I hadn’t considered. I thought it all over and after realizing that I would most likely lose my job, house, and maybe even the kids for sometime to my ex I reconsidered surgery. I called the pain doc and asked for a referral to another doctor who does injections. He asked me to come in on the following Monday at 7am and will discuss it. When I arrived it was a different set of nurses and him and he told me that he does injections. 20 minutes later I was getting the shot again. It was painful and the first didn’t really help at all but this upcoming Monday I will be getting my 3rd and final shot. I’m in no way cured. And if you don’t have insurance then surgery or shot is going to cost a lot. But what I have done is bought time. It’s allowing me to function on a larger scale and with the use of my meds also I’m not in uncontrollable pain all the time. I’ve made arrangements to have the surgery next spring and my employer has agreed to hold my position since spring is our slack season until I come back after a couple months. Long story short, the injection sucks as does the following days but it gives you a glimpse of hope and reminds you of what it’s like not to hurt nonstop.

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