Reducing Cortisone Shot Pain
A cortisone shot can hurt, especially when given into a knee or other joint, but a skilled provider usually can limit this pain.
Often, the cortisone injection can be done with a very small needle that causes little discomfort. Sometimes a slightly larger needle must be used, especially if your healthcare provider needs to remove fluid through the needle before giving the cortisone shot.
Some drugs, such as lidocaine or Marcaine , can be given with the cortisone shot to deliver temporary relief at the injection site. Also,;topical anesthetics applied directly to the skin;can help numb the affected area.
Cortisone injections into small joints or tight spaces may cause more discomfort than shots given in larger joints. For this reason, injections into the shoulder or knee may be less painful than those given at the finger joints, feet, and tendons.
Managing A Cortisone Flare
Icing a cortisone flare at the site of your injection should help reduce inflammation thats causing you pain. This is the first line of treatment for cortisone flares. You can take over-the-counter pain medication, such as ibuprofen or acetaminophen , to try to reduce the pain if icing the area doesnt help. Within a few days of receiving your cortisone injection, the pain from the flare should go away and you should feel relief.
If youre still in a lot of pain three to five days after you get the injection, you need to speak with your doctor.
Prolotherapy Brings Oxygen To The Joint To Help Provide Healing Cells Energy And A Clean Safe Work Environment
In a 2017 stem cell study Dr. Ming Pei of West Virginia University publishing in the medical journal Biomaterials;suggests that while adult stem cells are a promising cell source for cartilage regeneration, they have a hard time in a harsh joint environment when hypoxia and inflammation have created a toxic soup for the stem cells to work in. As noted above healing cells, like your native stem cells, like a clean, safe work environment. Chronic inflammation slowly and steadily brings about a low oxygen environment in joints because the body feels that diseased tissue will die in a low oxygen environment. Oxygen deprivation is designed to be a short-term drastic measure to healing a wound. But chronic inflammation means a slow strangulation of the joint
Sometimes we forget the cells of the body obtain their energy via aerobic metabolism.; The primary substrates or substances that are needed for aerobic metabolism are oxygen and glucose. The body breathes to get oxygen and we eat to break down the food into sugar. Even if a person just eats protein, ultimately the body finds a way to break down the protein into individual amino acids and eventually into glucose. Without glucose, the cells and the body cannot live.
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Cautions With Other Medicines
There are many medicines that can affect the way hydrocortisone injections work.
It’s very important to check with your doctor or pharmacist that a medicine is safe to mix with hydrocortisone injections before you start having them.
Who Can And Cannot Have Hydrocortisone Injections
Most adults and children, including babies, can have hydrocortisone injections.
Hydrocortisone injections are not suitable for some people. Tell your doctor before starting the medicine if you:
- have ever had an allergic reaction to hydrocortisone or any other medicine
- have ever had depression or manic depression or if any of your close family has had these illnesses
- have an infection
- are trying to get pregnant, are already pregnant or you are breastfeeding
- have recently been in contact with someone with chickenpox, shingles or measles
- have recently had, or you’re due to have, any vaccinations
Hydrocortisone injections can make some health problems worse so it’s important that your doctor monitors you.
Make sure your doctor knows if you have:
If you have diabetes and monitor your own blood sugar, you will need to do this more often. Hydrocortisone injections can affect your blood sugar control.
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Pros And Cons Of Cortisone Injections
Injections of Intra-articular corticosteroids , usually combined with analgesics, are commonly performed to treat pain related to osteoarthritis e.g., hip and knee OA. While they are common, they are not without their risks. I will go on to talk about these in a moment, however first, its important to understand they should only be considered after conservative methods of treatment have failed i.e., oral analgesics, anti-inflammatory agents, exercise or physiotherapy. Intra-articular corticosteroids should be not be first line treatment for OA pain, and if you are recommended for one soon after OA diagnosis or complaints of pain without much other initial intervention, I would encourage you to consider the following pros and cons of IACSs and question the recommendation.
Pros of IACSs
Cons of IACSs
The following adverse effects and side effects should be taken into consideration when given the recommendation of a corticosteroid injection.
Some side effects include :
- joint pain and swelling
While these side effects are certainly nothing to scoff at, more and more research is indicating that IACSs are causing long term serious and adverse effects of joint health; these adverse effects are highlighted below.
A new paper has identified some adverse events associated with IACS injections:;
- Accelerated OA progression
- Subchondral insufficiency fractures
- A risk of osteonecrosis
- Rapid joint destruction, including bone loss
Cortisone Injections Can Predispose A Joint To Infection Patients Have Reported Severe Pain Including Muscle Pain And Burning After A Cortisone Injection
In research from doctors at the University of Toronto wrote of the problem of injection infection.
Intraarticular hip injections of corticosteroids and hyaluronic acid may be used to treat hip osteoarthritis. Although the sterile technique is recommended to avoid infiltration of the joint with microorganisms normally found on the surface of the skin there remains a risk of infection.
HERE IS THE DIFFERENCE -Patients prior to hip replacement surgery may typically receive hip injections of corticosteroids and hyaluronic acid to manage their pain until surgery day.
Intraarticular hip injections of corticosteroids and hyaluronic acid may increase the risk of infection because of the immune system suppression characteristic of cortisone.
Therefore, in the setting of total hip replacement, preoperative receipt of a hip injection may increase the risk of infection, leading to early revision arthroplasty.
While the researchers were unable to determine what agent was injected into the joint prior to surgery, they concluded that the most likely therapies were;corticosteroids and hyaluronic acid, with or without a local anesthetic.
As hyaluronic acid has no proven benefit for hip osteoarthritis,;it is likely that most of the injections were of corticosteroids.
- Corticosteroid joint injection may have local immunomodulatory effects that may increase the risk of infection following hip replacement.
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How Are Cortisone Injections Of Soft Tissues Given
The medical professional administering the injection draws up the corticosteroid into a syringe. A local anesthetic may simultaneously be drawn into the syringe. Next, the area to be injected is selected. Typically, the skin over the area to be injected is sterilized with a liquid solution, either alcohol or Betadine.
Sometimes, the area is topically anesthetized by rapid cooling using a spray such as ethyl chloride. The needle of the syringe then is inserted into the tissue to be injected and the solution is ejected from the syringe into the area of inflammation. The needle then is withdrawn, and a sterile bandage is applied to the injection site.
What Are The Side
Like all medical treatments, there is the risk of an allergic reaction and a few other side effects. Talk to your health care provider about your health, side effects, and risks.In some people, cortisone shots:
- Cause Infection at the injection site. If you experience a fever or redness after your injection, see your orthopedic specialist immediately.
- Raise blood sugar levels. If you have arthritis and diabetes, you will need to monitor your blood sugar closely for a few days as the steroid makes its way into your bloodstream.
- May cause cortisone flares. If the medication crystallizes after it is injected into the joint, it can cause pain and swelling for a day or two. People who experienced this side effect said it was the arthritis pain.;
- Lighten skin. Cortisone can sometimes cause the permanent lightening of skin near the injection area.
- Unlike oral steroid medications, cortisone injections dont cause weight gain or water retention.
Before you have a cortisone injection, talk to your health care provider about your medications. He or she will also make sure you do not have an active skin infection or septic arthritis.
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What Types Of Knee Issues Call For A Cortisone Shot
Suppose you have osteoarthritis, post-traumatic arthritis from a previous injury, rheumatoid arthritis or bursitis. In that case, you may need a cortisone shot from time to time if you have a significant flare-up. If you have a knee injury from playing sports or wear and tear, such as a meniscus or ligament tear, you might need the shot to calm the pain and inflammation.;
Talk With Your Doctor About Whether Cortisone Shots Are Right For You
If you are considering cortisone shots, its valuable to understand that cortisone is an effective short-term solution. It is also important to discuss with your doctor whether your medical history makes cortisone a beneficial treatment for you. Remember, there are reasons not to use cortisone, even when it continues to provide pain relief. If these reasons apply to you, you may be advised to limit your use of cortisone. Or you may want to exhaust other treatments before considering cortisone.
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Cortisone Shot In Knee
Osteoarthritis is one of the most common forms of arthritis that affects the knees. Treatment for this condition usually involves getting a cortisone shot in knee. Injecting cortisone into a specific part of your body helps relieve pain and inflammation. Cortisone shots are usually injected into joints such as the ankle, hip, elbow, shoulder, spine and wrist to relieve pain.
How Steroid Injections Work
Steroids are a manmade version of hormones normally produced by;the adrenal glands,;2 small glands;found above the kidneys.
When;injected into a joint or muscle, steroids reduce redness and swelling in the nearby area. This can help;relieve pain and stiffness.
When injected into the blood, they can reduce inflammation throughout the body, as well as reduce the activity of the;immune system, the body’s natural defence against illness and infection.
This can help treat autoimmune conditions,;such as multiple sclerosis ,;which are caused by the immune system mistakenly attacking the body.
Steroid injections are different from the anabolic steroids used illegally by some people to increase their muscle mass.
Page last reviewed: 26 February 2020 Next review due: 26 February 2023
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Cortisone Can Make Bone On Bone Worse By Thinning Out The Meniscus But One Injection Appears Okay
One of the reasons that you are considering a knee replacement or are thinking about getting a cortisone injection is because you have been told you have a bone on bone knee. So the idea that cortisone may make this worse by thinning out your meniscus is concerning doctors.
In August of 2020 in the journal;Scientific Reports doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this researchs main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:
- Although intra-articular corticosteroid injections are commonly used for the treatment of knee osteoarthritis, there is controversy regarding possible side-effects on the knee joint structure.
- In this study, the effects of intra-articular corticosteroid injections on worsening the knee structure and creating greater pain were examined.
- Findings: No significant effect of the intra-articular corticosteroid injections were found on the rate of cartilage loss nor on any other knee structural changes or patient-reported pain scores. In conclusion, a single intra-articular corticosteroid injection for the treatment of osteoarthritis-related knee pain was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
Are There Alternatives To Cortisone Injections
Yes. Recent studies suggest that other injections can be helpful for arthritis and tendonitis with potentially fewer side effects.
Hyaluronic acid is a natural substance in normal joints and tendons. There is some evidence that hyaluronic acid injections provide longer pain relief in arthritis than cortisone. Also, we use hyaluronic acid for injections in plantaris-associated Achilles tendonitis.
Platelet-rich plasma is obtained by spinning whole blood from a patient. The plasma, which contains a high concentration of platelets and growth factors, is injected into tendons and joints. There is good evidence that PRP provides long-term pain relief for knee arthritis and some tendons. You can read more about the positive effects of PRP on arthritis and tendonitis. We have also written a blog on PRP injections for knee arthritis.
Finally, recent evidence suggests that combining the two hyaluronic acid and PRP might be better.
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What Should I Avoid While Taking Cortisone
Ask your doctor before receiving a vaccine. The vaccine may not work as well while you are using cortisone.
Avoid being near people who are sick or have infections. Call your doctor for preventive treatment if you are exposed to chickenpox or measles. These conditions can be serious or even fatal in people who are using cortisone.
Avoid drinking alcohol.
What Should I Do If The Pain Returns
While you might feel great after getting a cortisone shot in knee, you still need to address the underlying biomechanics of the knee. Medications and injections are only meant to give you an opportunity to get into a structured exercise program. This will help to unload the knee, and prevent the recurrence of pain and inflammation after you have stopped taking medication.
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Cortisone Shots Have Limitations
Most orthopedic providers will not give you more than three cortisone shots in one area in a year.;
The overuse of cortisone can damage the ligaments, tendons, and cartilage in your joints.;Since cortisone can adversely affect the tendons, orthopedic professionals do not use it to treat tendon pain near the ankles or kneecaps.
Cortisone shots do not cure damaged joints, but they can help you postpone or avoid surgery.
Repeated Injections Can Affect Soft Tissue
Too many injections over a short period of time can cause damage to the tendons, ligaments, and articular cartilage at the injection site.3 For this reason:
- If more than one injection must be given in the same joint, they should be spaced several weeks apart.4 Many doctors prefer waiting longerâat least 3 to 4 months.5
- Patients are advised to have no more than 3 or 4 injections in the same place per year.4
- A surgeon will typically require a 3-month waiting period after a cortisone injection before operating on the affected joint.
Tendons are particularly prone to degeneration and injury after a cortisone injection. Because of this risk, a doctor will not inject cortisone medication directly into a tendon, even if a tendon is suspected to be the root of the pain. Because cortisone works locally, an injected placed near a tendon can still reduce its inflammation.
In fact, the Achilles and patella tendons are particularly prone to injury post-injection, even if an injection is directed near, rather than in, the tendon. For this reason, doctors avoid cortisone injections for Achilles and patella tendinopathies.4
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What Are The Side Effects Of A Cortisone Shot
Generally, cortisone shots are very safe if used for the right reasons.
However, like any medical treatment, there are always possible side effects. There is a very small risk of allergy, infection, and skin thinning. A cortisone shot can cause an increase in pain for the first few days. There is some worry about long-term side effects such as weakening of tendon strength or further joint damage. For example, recent studies suggest that repeated cortisone injections can damage cartilage. Moreover, a cortisone injection can weaken tendon strength for a few weeks.; But we can reduce these concerns by using cortisone shots sparingly and for the right reasons. Also, using ultrasound to direct the injection into the right spot reduces the chances of a poorer result.
Reduce Inflammation With Steroids
Corticosteroid injections are useful for treating flare-ups of OA pain and swelling with fluid buildup in the knee, Richmond says.
These injections help relieve symptoms by reducing inflammation in the joint. But theyâre not a perfect solution in every case. If you’re considering this treatment, keep this in mind:
They work quickly. These injections offer âvery rapidâ relief, usually within 24 to 48 hours, Richmond says.
The benefit is short-term. On average, the pain relief lasts from 6 to12 weeks, Richmond says. Often, thatâs long enough to get you through a flare-up of osteoarthritis until your symptoms subside.
You shouldnât use them frequently. A corticosteroid shot often works best the first time, Altman says. After that, they tend to give less relief.
In most cases, Richmond tells his patients they can use these shots two to three times a year. Using them too often may damage cells in the knee that make cartilage.
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