Cortisone injections are used for treating many orthopedic problems including arthritis, tendonitis, and bursitis. Cortisone is an anti-inflammatory medication, not a painkiller. However, by reducing inflammation, pain often subsides. Cortisone injections are very safe to perform. Side effects tend to be rare and minor. However, there are a few things you should understand before having an injection of this medication. Illustration by Joshua Seong. © Verywell, 2017. Natural vs. Synthetic Cortisone Cortisone is a type of steroid closely related to a natural substance called cortisol. In your body, cortisol is produced in the adrenal gland and released when your body is under stress. Naturally produced cortisol is released into the bloodstream and is relatively short-acting. Injectable cortisone is synthetically produced and has many trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body's own product. The most significant differences are that synthetic cortisone is not injected into the bloodstream, but into a particular area of inflammation. Also, synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes). Note that cortisone is not the same type of steroid as a performance-enhancing drug. Not all steroids are the same! Types of steroids include cortisone, cholesterol, and sex hormones. Therefore, if you go to your doctor's office and get a steroid shot, it will do nothing to grow muscles that you hear about with cheating in sports. How Cortisone Helps Inflammation Cortisone is a very powerful anti-inflammatory medication. It's not a pain relieving medication; it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks. In addition to injected cortisone, many physicians will mix the cortisone with another medication that may provide pain relief effects. For example, orthopedic surgeons will often mix cortisone with a local anesthetic to provide both immediate and longer-lasting pain relief. In addition, that added anesthetic can be helpful from a diagnostic standpoint. If the pain relief occurs quickly, your doctor will know the local anesthetic was delivered to the right location, and therefore the cortisone will also be in the right spot. Potential Side Effects Like any drug, there are possible reactions, side effects, and complications that can occur with a cortisone injection. Some doctors often are not keenly aware of the side effects of cortisone as these tend to be limited (they resolve in a short amount of time) and your doctor may not see these effects as they tend to occur long after the patient has left the office. Many patients feel as though their doctor doesn't care about these sometimes significant consequences of cortisone. If that's the case, it's important to be aware of the possible side effects of any medication you take and inform your doctor if they occur. blood sugar often and adjusting the insulin doses, if necessary. If the blood sugar rises more than anticipated, you should contact the physician who manages your diabetes to see if additional treatment is necessary. Facial Flushing Patients may experience flushing sensation and redness of their face. This reaction is more common in women and is seen in up to 15 percent of patients who receive a cortisone shot. This can begin within a few hours of the injection and may last for a few days. Many doctors are unaware of how common this reaction is, and some may not appreciate how this can be upsetting to patients. The good news is that these symptoms do spontaneously resolve, but it may make patients think twice before having another shot. Pain and Cortisone Flare Reaction Some patients have discomfort after the injection and may experience an increase in pain 24 to 48 hours after being treated. This usually subsides quickly and can be aided with an ice pack and anti-inflammatory medication. Infection Whenever there is a break in the skin, like when a needle is used to administer cortisone, there is a chance of infection. Your doctor will sterilize the skin to minimize the risk of infection. Skin Pigment Changes Patients with darker skin should also be aware that cortisone may cause the skin around the injection site to lighten. This is not harmful. Loss of Fatty Tissue High doses of cortisone can have detrimental effects on some tissues in the body. When injected into fatty tissue, cortisone can lead to a problem called fat atrophy. Fat atrophy causes loss of fatty tissue, which can lead to dimpling of the skin or the thinning out of fat. Patients who get cortisone injections in the heel to treat plantar fasciitis may find walking painful as fat that usually cushions their steps may thin out. Tendon Rupture Cortisone can also cause weakening of tendons. This is one reason your doctor may limit the number of cortisone injections administered. Cortisone can also lead to tendon rupture, as is the case when cortisone is injected for Achilles tendonitis. how many cortisone injections can be given. Often, physicians do not want to give more than three, but there is not really a specific limit to the number of shots. However, there are some practical limitations. If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. For these reasons, many physicians limit the number of injections they offer to a patient. The most common number physicians tell their patients is that no more than three injections should be administered in the span of a year, in one location of the body. That said, there are physicians who use more cortisone than this, and others who are more judicious about administering steroid shots. Discuss with your doctor how often you should (or could) have an injection. Source
