What Can Cause Pain After a Steroid Shot

Understanding Cortisone Flares

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Cortisone shots offer fast and lasting relief for many people with joint pain, but not everyone has a good experience. Some people have a reaction to a cortisone shot called a flare.

Usually, the cortisone flare occurs within 24 to 48 hours of the shot and causes pain or inflammation around the injection site. This article looks at why these flares happen and how you can deal with the discomfort.

how to treat a cortisone flare

Verywell / Emily Roberts

Uses for Cortisone

Cortisone is a powerful anti-inflammatory treatment. The shots are commonly used to treat pain and inflammation caused by conditions like tendonitis, bursitis, and arthritis.

Side Effects

Problems with cortisone shots can range from mild to quite serious. For example, hemarthrosis (bleeding into the joint) can occur, especially if you are taking blood thinners for another condition. Be sure to tell your healthcare provider before a cortisone shot if you are taking these kinds of drugs.

Approximately 2% of people who receive a cortisone shot have an increase in pain in the area being treated. This is the "cortisone flare."

Other side effects may include:

  • Skin that becomes lighter at the injection site
  • Thinning of tissues around the site
  • Nerve damage
  • A temporary rise in blood sugar
  • Joint infection
  • Death of bone tissue near the site

Recap

Cortisone shots are used to treat people who have joint pain and inflammation, often at the knees and shoulders. But there are side effects. Some people have a cortisone flare reaction after the shot. It's usually easy to treat the flare yourself, but there are times when you may need to call a healthcare provider.

What Causes Flares

There are two causes of flaring after the shot. They are:

  • Needle puncture: This is rare, but your body may react to the needle injury with inflammation and pain.
  • Crystallization: Cortisone can form crystals in the body. These crystals can irritate the soft tissues, including the synovial tissue that lines the joints. This tissue can become inflamed.

Treatment

The best treatments for a cortisone flare are:

  • Rest: Resting the area where the shot was given will allow the inflammation to die down.
  • Ice: Applying an ice pack to the area, off and on, will reduce discomfort. Knowing how to ice the area properly will help you along the way.
  • Anti-inflammatory medications: You may want to take an over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen). It will reduce the symptoms of your cortisone flare. Check with your healthcare provider to make sure it's safe for you to take these drugs.

If pain, redness, or swelling begin several days or weeks after the shot, this is not a cortisone flare reaction. Call your healthcare provider, especially if you have a fever with these symptoms.

How Long Flares Last

Cortisone flare reactions are almost always brief, and typically will begin to ease within a few hours or days. That's especially likely as the cortisone begins to work on the inflammation.

If your symptoms get worse despite ice and over-the-counter pain relief, you should call your healthcare provider. Also call if pain, redness, swelling, or a fever begin several days or weeks after the shot, because that is not a flare reaction. Your healthcare provider can help to diagnose the reason.

Summary

Cortisone can deliver real relief from joint pain caused by inflammation, but some people will have a reaction from the shot. This is called a cortisone flare reaction.

In most cases, the discomfort from a flare reaction is treated with rest, ice, and over-the-counter medication. If pain and other symptoms don't go away in a day or two, or get even worse, call your healthcare provider.

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  1. 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

  2. Wijn SRW, Rovers MM, van Tienen TG, et al. Intra-articular corticosteroid injections increase the risk of requiring knee arthroplasty: a multicentre longitudinal observational study using data from the Osteoarthritis InitiativeThe Bone & Joint Journal. 2020;102-B(5):586-592. doi: 10.1302/0301-620X.102B5.BJJ-2019-1376.R1

  3. Fawi HMT, Hossain M, Matthews TJW. The incidence of flare reaction and short-term outcome following steroid injection in the shoulderShoulder & Elbow. 2017;9(3):188-194. doi: 10.1177/1758573217693808

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