Using Cortisone Shots for Inflammation

Learn about the benefits and side effects

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Cortisone injections are used to treat orthopedic (bone and muscle) problems, like the pain that comes with arthritis, tendonitis, and bursitis. Cortisone isn't a painkiller, though. It's an anti-inflammatory medication, and reducing inflammation is what decreases the pain.

Cortisone shots are very safe to give, and side effects tend to be rare and minor. However, there are a few things you should know before having one.

This article explains what the shots are and the types of pain they usually treat. It also takes a deeper look into the side effects of cortisone shots, and some cases where caution may be needed.

Potential Side Effects of a Cortisone Shot

Verywell / Joshua Seong

Cortisone vs. Cortisol

Cortisone is a type of steroid closely related to the cortisol hormone that your body naturally makes. Your adrenal glands produce cortisol and release it when your body is under stress. Cortisol helps the body respond to stress in various ways, one of which is reducing inflammation.

Cortisone shots are synthetically made, meaning they're a manufactured drug that mimics your body's natural product.

Types of steroids include cortisone, cholesterol, and sex hormones. Note that not all steroids have the same effects.

Cortisone is not the same type of steroid as an anabolic steroid used to build muscle, for example. If you receive a steroid shot at your healthcare provider's office, it will not cause the kind of muscle growth or health problems seen in athletes and others who abuse anabolic steroids.

Uses

Cortisone is a very powerful drug. By injecting the cortisone into a targeted area of inflammation, strong doses of the steroid can be given while limiting possible side effects. Cortisone shots usually work within a few days, and the effects can last up to several weeks.

Many healthcare providers will mix the cortisone with a pain reliever. Orthopedic surgeons, for example, will often mix cortisone with a local anesthetic to offer both immediate and longer-lasting pain relief.

The added anesthetic also can help healthcare providers diagnose the exact problem. If the pain relief happens fast, your healthcare provider will know the anesthetic went to the right spot, and therefore the cortisone will be in the right place too.

Conditions Cortisone Helps

In cases where inflammation is an underlying problem, cortisone shots may be part of the treatment. These conditions include, but are not limited to:

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 (bupivacaine), 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.

Recap

Cortisone shots may offer relief that lasts for weeks when treating knee, shoulder, and other joint inflammation. The needle is usually small and there isn't a lot of discomfort when a healthcare provider gives the shot. Sometimes the shot will be mixed with an anesthetic to offer more pain control.

Side Effects

Like any drug, there are possible reactions, side effects, and complications that can occur with a cortisone shot. Side effects usually happen long after you leave the office and tend not to last long.

Systemic Side Effects

Systemic side effects occur because the small amount of cortisone entering your bloodstream affects your whole body, not just the site where the cortisone was given.

These body-wide effects are rare and usually minor. The targeted cortisone shot isn't the same as taking oral steroids, or having cortisone injected directly into the bloodstream, so only a small amount of the drug is absorbed into the blood.

Since the body produces its own natural cortisol, most people do not experience systemic effects. Those who do may have the following problems:

High Blood Sugar

High blood sugar is the most common reaction seen in people with diabetes. Cortisone can cause a temporary rise in blood sugar, so levels need to be closely monitored.

People taking insulin should be especially careful, checking their blood sugar often and adjusting their insulin doses as needed. If your blood sugar rises more than expected, you should call your healthcare provider to see if additional treatment is needed.

Facial Flushing

Some people say they feel flushed and have redness in the face, though this happens more in women. Facial flushing can begin within a few hours of the injection and may last for a few days. It also can happen again with any later rounds of cortisone shots.

Many healthcare providers are unaware of how common this reaction is, and some may not realize how this may upset people. The good news is that these symptoms do go away on their own, but it may make people think twice before having another shot.

Local Side Effects

Local side effects are those that happen only in the one area of the body where the cortisone shot was given. The local side effects of the shot are also rare, but you should know what to do if they happen to you:

  • Pain and ​cortisone flare reaction: Some people have discomfort after the shot and may experience an increase in pain 24 to 48 hours after being treated. This usually goes away quickly and can be relieved with an ice pack and anti-inflammatory medication.
  • Infection: Whenever there is a break in the skin, like when a needle is used to give cortisone, there is a chance of infection. Your healthcare provider will sterilize the skin to minimize this risk.
  • Skin color changes: People with darker skin should know 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 harm some tissues in the body. One problem is called fat atrophy. This means there is a loss of fatty tissue, and it can lead to dimpling of skin or the thinning out of fat. People who get shots in the heel to treat plantar fasciitis may find walking painful as the fat that cushions their steps may thin out.
  • Tendon rupture: Cortisone can cause tendons to weaken or rupture (break). Tendons are the tough bands of tissue that connect muscles to bones. This is one reason your healthcare provider may limit the number of cortisone shots you can have. Tendon rupture is particularly a risk when cortisone is used for Achilles tendonitis.

Are the Shots Safe?

Cortisone injections are extremely safe, but they do still have some risks.

Many healthcare providers will offer an injection as they are quick, easy, and usually work. Your healthcare provider should be able to provide other helpful treatments, though, if you cannot have or don't want a cortisone shot.

If you have had side effects with cortisone shots in the past, be sure to let your healthcare provider know what condition was being treated and how severe the side effects were. This will inform decisions about whether or not you have another shot for the same or a different problem.

Recap

Cortisone is an effective treatment for many orthopedic conditions, but there are side effects. If you have concerns about a cortisone shot, talk with your healthcare provider. The good news is that, in many cases, there are other options that can be used to treat the problem.

Treatment Plan

There is no rule as to how many cortisone injections can be given. While there is not really a limit to the number of shots, there may be some practical problems.

If a cortisone shot wears off quickly or does not help, then doing it again may not be worth it. Also, some studies have shown cortisone shots may weaken tendons and cartilage. Repeated cortisone injections multiply these effects and increase the risk of problems.

That's why many healthcare providers limit the number of shots, usually to no more than three in one year at the same site. But there are healthcare providers who use more cortisone than this, and still others who may recommend fewer shots. Talk with your healthcare provider about how often you can have an injection.

Summary

Cortisone shots are a powerful tool and a good treatment option. But they may be overused or, in some cases, not the best choice.

The shots should only be used to treat inflammation, not just injected for pain. They also should be limited, especially in younger people with healthy joints and tendons that may be damaged by repeated shots.

Healthcare providers should be aware of cortisone's side effects and tell people about these possible risks. Be sure to bring up the topic if your healthcare provider doesn't do so first.

A Word From Verywell

Many people have strong feelings about cortisone shots: if they're magic, if they're horrible, and if they should even be used. It's a relief to know there is help available to ease your pain, but cortisone shots are not without their risks.

It's a good idea to look at all your options for managing pain and then talk them over with a trusted healthcare provider.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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