Cortisone Injection: Outcomes, Risks, Advantages, and Preparation Before the Procedure
Cortisone shots, injections of a synthetic version of the cortisone hormone, have proven to be a valuable tool in treating a wide range of conditions such as allergies, asthma, and inflammatory bowel disease. They work by suppressing the immune system response, fighting inflammation, and narrowing blood vessels, among other functions [1].
However, these powerful drugs come with potential side effects. Cortisone shots may lead to serious unwanted health effects such as osteoporosis and bone fractures, muscle loss, weakness and fatigue, nausea, vomiting, diarrhea, impaired growth in regular child users, infections, cataracts, sleep disturbances, anxiety, restlessness, and psychosis [1].
More common, but less serious, side effects include pain, discomfort, or bruising near the injection site, loss of fat near the injection site, changes in skin color near the injection site, increased blood sugar levels for several days in people with diabetes, and temporary increases in blood pressure in people with high blood pressure [1].
The speed at which cortisone shots work varies, with some taking a few days to start working and others beginning to work within hours of the injection [2]. It's important to note that corticosteroids can interact with other medications, such as anticoagulants, and doctors may recommend reducing dosages before a cortisone shot [3].
One area of concern is the long-term use of cortisone shots, particularly in relation to bone health. Frequent cortisone injections can lead to long-term side effects such as cartilage thinning, tendon weakening, loss of bone density, osteoporosis, and in severe cases, avascular necrosis (death of bone tissue due to lack of blood supply) [1][3][5].
Repeated cortisone injections can cause thinning of cartilage in the injected joint, potentially worsening joint function [1]. They can also weaken tendons around the injection site, raising the risk of tendon rupture [1]. Additionally, they can reduce bone density, increasing the risk of osteoporosis—loss of bone mass making bones more fragile [1][5]. Avascular necrosis, a rare but serious condition where the bone tissue dies due to disrupted blood supply, may occur especially with long-term and high-dose steroid use and leads to bone collapse and arthritis [3].
These effects result from corticosteroids' ability to interfere with bone remodeling and repair, reduce blood flow, and affect metabolism of bone cells. Although joint injections are generally considered safe when used sparingly, frequent or high-dose use raises the risk of these complications [1][2].
Patients receiving multiple cortisone shots should discuss risks and benefits with their healthcare provider and consider alternative treatments to mitigate these potential long-term effects on bone health. The duration of a cortisone shot's effectiveness can depend on the amount injected and interactions with other medications. A person should not usually receive more than three cortisone shots per year in the same part of the body [4].
It's also worth noting that there may not be any noticeable health effects until a later time after the cortisone shot begins to work [1]. Cortisone shots can improve the outlook of a person with multiple sclerosis (MS) by suppressing their immune system [6]. They can also improve a person's symptoms in rheumatoid arthritis (RA) by reducing the inflammation that this condition causes in their joints [7].
Some antiviral drugs can reduce the effects of certain corticosteroids, and corticosteroids can interact with COVID-19 vaccines, but a recent study found no evidence that epidural corticosteroid shots make COVID-19 vaccines less effective or more dangerous [8].
In most cases, doctors do not give cortisone shots to people who have had another cortisone injection within the last 6 weeks [9]. Cortisone shots can be administered in several ways, including intra-articular (into a joint), intramuscular (into a muscle), intravenous (into the blood), and epidural (into the spine) [10].
In conclusion, while cortisone shots can be a valuable tool in treating various conditions, it's crucial to be aware of their potential side effects, particularly long-term effects on bone health. Patients should discuss these risks and benefits with their healthcare provider and consider alternative treatments when possible.
References: [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665077/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841769/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816208/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283966/ [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665077/ [6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673720/ [7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555615/ [8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491954/ [9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665077/ [10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665077/
The immune system is often suppressed by cortisone shots, a treatment used for various medical conditions like allergies, asthma, and inflammatory bowel disease [1]. However, long-term use of these therapies and treatments can have adverse effects on health and wellness, particularly bone health, as they may lead to conditions such as osteoporosis and bone fractures [1]. Alternative treatments should be considered to mitigate these potential long-term effects. In some cases, cortisone shots can improve health outcomes, for example, in people with multiple sclerosis or rheumatoid arthritis by reducing inflammation [6, 7].
