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.
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, patients must evaluate risk/benefit more objectively.
A cortisone, or epidural, injection is a common temporary remedy for inflammation-related pain. Cortisone refers to a category of man-made steroids that mimic the effects of cortisol, a hormone that naturally occurs in the body. It is not without side effects. Don’t confuse topical and oral cortisone with injections. Each has its own side effects. Complications of cortisone shots can include:
- Joint infection
- Nerve damage
- Thinning of skin and soft tissue around the injection site
- Temporary flare of pain and inflammation in the joint
- Tendon weakening or rupture
- Thinning of nearby bone (osteoporosis)
- Whitening or lightening of the skin around the injection site
- Death of nearby bone (osteonecrosis)
- Temporary increase in blood sugar
Repeated 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, patients are generally observed for such adverse reactions so prompt remedies can be administered. To minimize risks, doctors caution against repeated injections within a short time.
During the procedure and depending upon location, patients may be offered a local anesthetic or one administered 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 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 should not be taken as license to resume risky behavior like heavy lifting or running. Treating lumbar facet joint pain with pulsed radiofrequency (PRF) is relatively simple 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. Discuss any the purpose and target outcome with your doctor both prior to the procedure and during follow up visits.
- Cortisone shots. mayoclinic.org
- Cortisone Injection Risks and Side Effects. arthritis-health.com
- Cortisone Injections (Steroid Injections). arthritis-health.com
- A New Technique to Treat Facet Joint Pain With Pulsed Radiofrequency. Pietro Martino Schianchi, 2015, nih.gov