Do Cortisone Injections Hurt?

What to Expect and Ways to Reduce the Pain

woman getting a cortisone shot

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Cortisone is a commonly used medication to treat a variety of orthopedic conditions. The medication is a powerful anti-inflammatory treatment that can be administered directly to a site of inflammation in the body. Therefore, cortisone injections are commonly used in the treatment of conditions such as tendonitis, bursitis, and arthritis.

Injection Site Pain

Injections vary in the amount of discomfort they cause. Some factors that can affect the pain of the injection include the location of the injection and the size and gauge of the needle.

In the end, certain cortisone injections will hurt no matter what is done. Injections into the palm of the hand and sole of the foot are especially painful. By and large, the injections tend to hurt most when the cortisone is delivered to a small space.

The size (length) and gauge (width) of the needle can also inform the amount of pain you experience. Not surprisingly, larger needles cause more discomfort than smaller ones.

While your first instinct may be to ask your doctor for a smaller needle, the choice is ultimately constrained by the location of the injection. For example, cortisone injected into a knee space needs to be robust enough to pass through the connective tissues of the knee.

Moreover, the viscosity (thickness) of the medication may require a larger gauge needle as opposed to a smaller one used for subcutaneous (under the skin) injections.

Your doctor will select the size of the needle based on the problem being treated.

Helpful Tips

If you're worried about the pain from an injection, let your doctor know. Ask if your doctor can try other techniques to alleviate the discomfort. Some helpful techniques include:

  • Ask if a smaller needle is possible. In some cases, it can be traded out. But in others, such as when the doctor needs to remove fluid from a joint space (called joint aspiration), it can't. A larger needle will be needed to accommodate the inherently viscous synovial fluid.
  • Request a numbing agent. Topical anesthetic and cold sprays can help numb the skin and reduce the sensation of the injection. Another option is to "prep" the skin with a small needle and follow up with a larger needle for the actual injection. It actually helps.
  • Avoid rushing. Some people like getting an uncomfortable procedure over with quickly. But if you are extremely nervous, let your doctor know. By taking a little extra time and asking your doctor to talk you through the procedure, you may feel less out of control or panic-stricken. It can make a big difference.
  • Relax. Take slow, deep breaths. If possible, ask your doctor if you can get the injection lying down. Put in your earbuds and listen to some calming music or atmospheric sounds. While the procedure may seem like hours, remind yourself that it only a few minutes out of your life.

When to Call Your Doctor

While infections are uncommon following a cortisone shot, call your doctor if you develop a high fever (over 100.4 F), severe pain, increased swelling, a bloody or pus-like discharge, or a deep red or purplish skin color.

Post-Injection Pain

While pain can occur during a shot, there can also be discomfort after the shot. One of the most common side effects is a cortisone flare. The cortisone flare occurs in the hours and days after receiving a cortisone shot, typically leading to increasing levels of pain and discomfort. 

While the pain will often subside on its own, there are some effective ways to reduce the symptoms more quickly, including:

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  1. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. doi:10.1016/S0140-6736(10)61160-9

  2. Veritas Health, LLC. Cortisone injection risks and side effects. 2016.