MD REVIEW

Pros and Cons of Cortisone Injections

People who are not ill respond differently to the mention of medication side effects than those who are patients.

Cortisone is Sometimes Good and Bad

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Few, if any, pharmaceutical drugs have zero side effects. Contra­indications might deter patients with tolerable pain levels. But when pain or illness seriously impacts one’s quality of life, people evaluate risk/benefit more objectively.

Cortisone, or epidural, injection is a common temporary remedy for inflammation-related pain. Cortisone is a category of man-made steroids that mimic the effects of cortisol—a hormone that naturally occurs in the body.

Cortisone presents several risks and side effects. Don’t confuse topical and oral cortisone with injectables. Each has its own issues. Complications of cortisone shots can include:

  1. Joint infection
  2. Nerve damage
  3. Thinning of skin and soft tissue around the injection site
  4. Temporary flare of pain and inflammation in the joint
  5. Tendon weakening or rupture
  6. Thinning of nearby bone (osteoporosis)
  7. Whitening or lightening of the skin around the injection site
  8. Death of nearby bone (osteonecrosis)
  9. Temporary increase in blood sugar

Repeating injections may cause joint cartilage to deteriorate. (Weight gain and water retention are associated with oral cortisone.) Rarely, the injection site might become infected.

Some patients have uncommon allergic reactions to either the local anesthetic added to the injection or to cortisone itself. Following the procedure, medical personnel generally observe patients for such adverse reactions. If necessary, they can administer prompt remedies to minimize risks. Doctors caution against repeating injections within a short time.

During the procedure, and depending upon location, patients may receive a local anesthetic or one by an anesthesiologist. It is very important to immobilize patients when performing injections into the spine. A powerful drug like fentanyl and/or percocet may be used. These drugs can have their own side effects, like migraines, hours or days afterwards.

You might hear a doctor say, ‘We are going to treat, but not cure the condition.’ A cortisone injection is given to help relieve persistent symptoms of conditions like osteoarthritis, facet joint syndrome, rheumatoid arthritis, or disc herniation. Feeling better afterwards is not license to resume risky behavior like heavy lifting or running. Treating lumbar facet joint pain with pulsed radiofrequency (PRF) is relatively simple alternative without serious complications.

What is the benefit of an epidural if it does not cure the underlying condition? Reduction in inflammation may give the joint time to heal or increase mobility for physical therapy. Sometimes the main benefit of cortisone is diagnostic. If mobility increases after injecting a particular joint, the physician knows the source of the pain. Discuss both the purpose and target outcome with your doctor prior to the procedure and during follow up visits.

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Kevin Williams is a health advocate, artist, pro­gram­mer, and writer of hundreds of articles for multiple web­sites. He has 17 years experi­ence as a Neutrogena Research and Scientific Affairs graphics con­sul­tant.

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