A cortisone injection, also known as a steroid or corticosteroid injection, is used to reduce inflammation.
It is a shot that mimics the effects of cortisol, a hormone produced in the body by the adrenal glands. It reduces the interaction between white blood cells in the immune response, which in turn reduces inflammation.
After the shot, some people may experience a side effect known as a cortisone flare. They may have pain in the joint where the shot was given. This pain tends to go away after a few days.
In this article, we examine the pain and other side effects that may occur after a cortisone injection. We also look at cortisone injections in general, including how long they last and recovery after having one.
A cortisone flare is the most common immediate side effect of a cortisone injection.
Some people may notice a flare-up of pain in the joint for the first 24 hours after receiving the injection, although this is rare. The discomfort can often be managed by taking over-the-counter painkillers.
Flares can last for 2-3 days. As well as intense pain, people may have a buildup of fluid around the affected joint.
Other factors or side effects may cause pain after a cortisone injection.
Besides general pain and discomfort immediately after the shot, other side effects that may cause pain include:
- Infection: This causes redness, swelling, and pain. Infection is rare but requires immediate medical attention to prevent joint damage. It is most common in people with diabetes.
- Bruising: This should be temporary.
- Pounding headache: An injection to the spine can occasionally cause this. It should go away on its own, but the individual should tell their doctor if it happens.
In general, cortisone injections are delivered with minimal to no side effects. However, the stronger the mixture, the higher the chance there is of side effects occurring.
In addition to pain, side effects can include:
- flushing of the face
- loss of fat where the injection was given, which may cause permanent dimples
- paler skin where the injection was given, which may be permanent
- increased blood pressure
- raised blood sugar levels
- temporary changes to a woman's periods
- increased appetite
- changes in mood
- difficulty sleeping
People should contact their doctor if they have any concerns about side effects they are experiencing.
Some people will be given a local anesthetic alongside their cortisone injection. If a local anesthetic is used, then the shot may cause numbness that can last for up to 24 hours.
This can make driving difficult, so the individual may want to arrange transport home from the hospital after receiving the injection.
Another option is an anesthetic spray, which can be sprayed onto the site of the injection to the numb the skin. Using this spray does not make driving difficult.
If the injection was made directly into a joint, then people are advised to rest that body part for 1 to 2 days, or at least avoid heavy exercise.
However, if the person is undergoing physiotherapy, then the physiotherapist may want to continue treatment immediately while the joint is less painful.
In some cases, such as when other treatment is not working or is less effective, repeated cortisone injections are given. In general, these are only used as a short-term solution to give the doctor time to work out the right medication.
People looking for a long-term solution are often advised to undergo physical therapy or make certain lifestyle changes, such as losing weight or changing footwear.
There is no reason for someone not to drink alcohol after receiving a cortisone injection. The shot should not affect fertility, pregnancy, or breast-feeding. However, people who are pregnant or breast-feeding should tell their doctor before having a cortisone injection.
An injection is used for OA when:
- it is painful
- there are sudden and painful attacks
- someone needs to get through an event, such as a holiday or wedding
A doctor will decide what steroid mixture and what dose to give in a cortisone injection, based on the condition and symptoms.
A specialist, such as a rheumatologist, will usually give the injection. The injection site will depend on where the pain and inflammation are.
A cortisone injection can be given in several different ways, including:
- into a joint, known as an intra-articular injection
- into a bursa or fluid-filled sac associated with a joint, known as an intra-bursal injection
- into a muscle, known as an intramuscular injection
- into the spine, known as an epidural injection
- into the blood, known as an intravenous injection
- around tendons, known as a peritendon injection
If the individual has the injection for pain, then it may also contain a local anesthetic. If the pain improves immediately, this confirms that the correct area was injected.
A person should be able to go home after the injection but may need to rest the area that was treated for a few days.
They should be able to take other medications alongside a cortisone injection. However, if they are taking a blood-thinning medication, such as warfarin, an additional blood test may be needed to make sure the blood is not too thin. This is because of a risk of bleeding into the joint.
A cortisone injection will usually take a few days to start working, although sometimes they work within a few hours.
People who have had injections with a local anesthetic will experience pain relief immediately or within a few minutes, but this will wear off after around half an hour unless the anesthetic is particularly long-lasting.
The pain relief a cortisone injection provides does not last forever. It is estimated that the duration of pain relief will be no longer than 2 months, on average.
For people with OA, a cortisone injection may improve pain for several weeks, months, or even longer, especially for OA of the knee or thumb.
Anyone receiving repeat injections may notice that their pain relief lasts less and less time. This is not because they have built up a tolerance to the cortisone, but because their joint is getting worse.