Cortisone shots, also known as steroid injections, deliver medication directly to a specific area of the body to alleviate pain and reduce inflammation. These injections contain corticosteroids, manufactured drugs resembling cortisol, a hormone naturally produced by the adrenal glands. They calm the body’s inflammatory response in a localized region, providing pain relief. While effective, it is important to understand their potential downsides.
Common Localized Reactions
Following a cortisone injection, some individuals may experience localized reactions at the injection site. A common occurrence is a temporary increase in pain, swelling, and irritation, often referred to as a “cortisone flare.” This flare typically begins within 24 to 48 hours and usually subsides within a few days as the corticosteroid takes effect. Applying ice and over-the-counter pain medication can help manage this discomfort.
Other localized effects include bruising. Temporary changes to the skin at the injection site are also possible. These can manifest as skin lightening (hypopigmentation), which may be more noticeable in individuals with darker skin tones, or thinning of the skin and soft tissue. While generally not harmful, these changes can be cosmetically undesirable and may take weeks to months to resolve.
Broader Health Implications and Serious Complications
While cortisone shots are primarily localized treatments, the medication can enter the bloodstream and potentially lead to broader health implications, though systemic effects are often small. For individuals with diabetes, a temporary increase in blood sugar levels is a known side effect, typically lasting for about five to seven days post-injection. Patients with diabetes may need to monitor their blood sugar more frequently and consult their healthcare provider for medication adjustments.
Cortisone injections can also cause a temporary elevation in blood pressure due to fluid retention. This effect usually resolves within a few days. Some people report mood changes, including feeling high, irritable, anxious, or difficulty sleeping. These psychological effects are generally mild and temporary, but severe symptoms are possible in rare instances.
Less common but more serious localized complications can occur. These include severe infection at the injection site, requiring immediate medical attention. Nerve damage is a risk if the needle improperly contacts a nerve. Injections near tendons can weaken them, increasing the risk of tears or rupture, particularly in areas like the shoulder or Achilles tendon. Thinning of fat or skin tissue can occur, and in rare cases, osteonecrosis (death of nearby bone) has been reported with repeated use.
Limitations and Considerations for Repeated Use
Cortisone shots offer temporary relief from pain and inflammation, but they do not address the underlying cause of the condition. The duration of relief varies, typically lasting from a few weeks to several months. Symptoms may return once the medication wears off.
Repeated injections in the same area raise concerns about long-term tissue damage. Frequent cortisone shots can weaken cartilage within a joint, potentially accelerating joint degeneration or contributing to cartilage loss. Similarly, repeated injections can lead to thinning of nearby bone or increased susceptibility to osteoporosis.
Healthcare providers typically limit the number of cortisone shots in a specific area to avoid cumulative risks. Guidelines suggest no more than three or four injections in a single joint per year, with at least 12 weeks between. Exceeding these recommendations can lead to diminishing returns in pain relief and an increased likelihood of adverse effects.