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

07/31/2014 | 6 min. read

Dr. Joseph Pergolizzi

Dr. Joseph Pergolizzi

If 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.)

What Are the Pros of Cortisone Injections?

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.

What Are the Cons of Cortisone Injections?

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.

My Opinion About Cortisone Injections

First of all, chronic pain can be devastating and you have a right to seek help in controlling it. I have and likely will continue to prescribe cortisone injections to certain patients. The biggest drawback of cortisone injections is that they are a short-term solution to what may be a long-term condition. If you have ongoing, persistent joint pain, for example, a cortisone injection is like a payday loan. It may help you get by right now, but you can’t live on them.

If you, like millions of other Americans, suffer from chronic pain, I believe you first need a long-term, sustainable, drug-free multi-modal treatment strategy to keep pain under control. Then you can use cortisone injections or other drugs or treatments to manage the rough spots.

Managing Your Chronic Pain Without Drugs

There are many things you can do to reduce your pain. These things may not get rid of your pain entirely, but I have never found a patient who did not get at least some pain relief from these steps.

  • Eat a sensible diet. Processed food can contribute to headaches, obesity (which contributes to joint pain), inflammation, and other conditions. Junk food is pain food. Learn more about how to create a "pain diet."
  • If you use artificial sweeteners, try to go cold turkey for a couple of weeks and see if it reduces your pain. The FDA has a long list of complaints from people who say that artificial sweeteners caused them joint pain, fatigue, and headache. Many people overlook this very common cause of extra pain in their lives.
  • Get plenty of sleep. Sleep deficits and pain go hand-in-hand.
  • Exercise. Depending on your age, physical condition, and degree of pain, this may be nothing more than a walk around the block or some light water aerobics, but go out and get moving. If all you can do is sit in a chair and lift a three-pound dumbbell, do that. The point is to exercise to the limit that you safely can. This may be the single best pain reliever there is. When you exercise close to your limit (and you may have to build up to that), your body releases endorphins, which are nature’s own pain reliever.
  • Find some safe, natural remedies to treat you pain. This may include topical oils and topical pain relievers, ice packs, massage, heating pads, and herbal supplements.

These changes amount to modifying your lifestyle, but let’s face it: If you do not seriously make these changes, chronic pain is going to change your lifestyle for you. So why not take control and modify your lifestyle first? These tips will help!

  • Nurture a good attitude about lifestyle modification.
  • Think positively about the changes you want to make; think of these changes are benefits and privileges, not punishment.
  • Don’t beat yourself up if you stumble. Setbacks are normal. Just get back on track.
  • Don’t start tomorrow. Start now!

Now it's your turn: Have you ever had a cortisone injection?

You May Also Be Interested In

Dr. Joseph Pergolizzi

Meet Dr. Joseph Pergolizzi

Dr. Joseph Pergolizzi is an internationally recognized expert in pain medicine who has spent much of his career studying what pain is, why it occurs, and how best to treat it. That experience has led him to believe strongly that there are often ways to relieve or manage pain which are overlooked or discounted, and that the most effective treatment approaches are always multi-modal.

More About Dr. Joseph Pergolizzi