What Can Cause Pain After a Steroid Shot

Understanding Cortisone Flares

A cortisone flare is a reaction to a cortisone injection. Usually, this flare reaction is experienced shortly after the injection, typically within 24 to 48 hours, and causes pain and/or inflammation around the injection site.

Often, cortisone shots can provide rapid and lasting relief from symptoms of an inflammatory condition, but not everyone has a positive reaction to a cortisone shot.

how to treat a cortisone flare
Illustration by Emily Roberts, Verywell

Cortisone Injection Uses

Cortisone injections are a commonly used treatment by orthopedic surgeons and other physicians. Cortisone is a powerful anti-inflammatory medication that can be used for a broad array of orthopedic ailments, typically in the joints, such as tendonitis, bursitis, and arthritis.

Other Side Effects

There are potential side effects of cortisone shots that can range from a minor annoyance to serious problems. These include:

  • Skin around the injection area becoming lighter or white
  • Skin and tissue around the injection area becoming thinner
  • Nerve damage
  • Blood sugar increasing temporarily
  • Infection in the joint
  • Bone that's near the injection area thinning or dying

Why Cortisone Flares Occur

There are two causes of a cortisone flare:

  • Needle puncture: Placing a needle through the skin causes an injury to the body. Your body may react to this needle injury with inflammation and pain.
  • Crystallization: Injected cortisone can form crystals, which can irritate the soft tissues, including the lining of joints (the synovial tissue). This tissue can become inflamed, causing a reaction called crystalline synovitis.

How to Treat a Cortisone Flare

The best treatments for a cortisone flare are:

  • Rest: The first recommended treatment is resting the area injected with cortisone to allow the inflammation to subside. This is usually accomplished by simply not engaging the body part in any strenuous activity.
  • Ice: Apply an ice pack to the area, off and on, for the first few days. Knowing how to ice the area properly will help you along the way.
  • Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications (NSAIDs) like Advil or Aleve are some of the most commonly prescribed medications for problems such as a cortisone flare. Check with your doctor to make sure it's safe for you to take these medications.
  • Ice: Apply an ice pack to the area, off and on, for the first few days. Knowing how to ice the area properly will help you along the way.

Ice is probably the most effective treatment for a cortisone flare and will often make the symptoms subside fairly quickly.

Duration of Cortisone Flares

Cortisone flare reactions are almost always limited in their response. Typically within a few hours or days, the flare reaction will begin to subside, especially when the cortisone medication begins to have its effects on reducing inflammation.

If the pain continues to worsen despite the above treatments, you should contact your doctor. Many patients who seem prone to developing these flare reactions will choose not to have cortisone injections for treatment of inflammation in the future, so if you do have this response you should let your doctor know.

Was this page helpful?
Article 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.
  1. Alsop RJ, Khondker A, Hub JS, Rheinstädter MC. The lipid bilayer provides a site for cortisone crystallization at high cortisone concentrations. Sci Rep. 2016;6:22425. doi:10.1038/srep22425

  2. Holland C, Jaeger L, Smentkowski U, Weber B, Otto C. Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int. 2012;109(24):425-30. doi:10.3238/arztebl.2012.0425

  3. Waterbrook AL, Balcik BJ, Goshinska AJ. Blood glucose levels after local musculoskeletal steroid injections in patients with diabetes mellitus: A clinical review. Sports Health. 2017;9(4):372-374. doi:10.1177/1941738117702585

  4. American Society for Surgery of the Hand. Cortisone shot.