What Can Cause Pain After a Steroid Shot

Understanding Cortisone Flares

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A cortisone flare is a reaction to a cortisone injection. Usually, this flare reaction occurs within 24 to 48 hours of the injection 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 is a powerful medication that has anti-inflammatory properties. Cortisone injections are commonly used for the treatment of ailments affecting the joints, such as tendonitis, bursitis, and arthritis. 

Other Side Effects

The adverse effects of cortisone shots can range from a minor annoyance to serious problems. Hemarthrosis (bleeding into the joint) can occur, especially if you are taking anticoagulation medications or blood thinners for another condition. Be sure to inform your doctor prior to your scheduled injection if you are taking these medications.

Other potential side effects include:

  • Discoloration of the skin around the injection area, which can become lighter
  • Thinning of the skin and tissue around the injection area
  • Nerve damage
  • A temporary rise in blood sugar
  • Joint infection
  • Thinning or necrosis (dying) of bone near the injection site

Why Cortisone Flares Occur

There are two causes of a cortisone flare:

  • Needle puncture: While it's a rare reaction, your body may react to the 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, leading to a crystalline synovitis reaction.

Treatment

The best treatments for a cortisone flare are:

  • Rest: Resting the injected area often allows the inflammation to subside.
  • 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: Your doctor might recommend that you take an over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs) like Advil or Aleve to reduce the symptoms of your cortisone flare. Check with your doctor to make sure it's safe for you to take these medications.

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 self-limited. Typically, the flare reaction will begin to subside within a few hours or days, especially when the cortisone begins to have its intended effect of reducing inflammation.

If your pain continues to worsen despite the above treatments, you should contact your doctor. 

If pain, redness, or swelling begin several days or weeks after the injection, this is not a flare reaction. Furthermore, an associated fever is not a hallmark of a flare reaction.

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