Remember the Carly Simon song “I Haven’t Got Time for the Pain”? She may have been talking about heartbreak, but arthritis pain is something you don’t want to make time for either. When you have osteoarthritis or a type of inflammatory arthritis, such as rheumatoid arthritis or gout, you may get used to living with daily chronic pain, but when an acute arthritis flare occurs, it can really throw you off your daily routine and ability to work, be active, run errands, etc. That’s where corticosteroid injections (cortisone shots) come in — a treatment option for acute bouts of pain.
Before Cheryl Ackerman was diagnosed with rheumatoid arthritis, she was experiencing pain so excruciating that she could barely walk, sit, or stand for any length of time. Per a doctor’s recommendation, she received corticosteroid shots in both of her knees, neck, and back. “After about three weeks I finally felt the full effect by the inflammation going down and this gave me great relief,” says Ackerman, who is from Florida. Even with the maintenance and pain, Ackerman says getting the injections is worth it. “They have improved my quality of life living with rheumatoid arthritis immensely.”
Steroid injections can relieve pain and improve mobility for many people, but they don’t work equally well for all types of arthritis. There are also important precautions about how frequently you can safely receive them. Here’s what you need to know before you face the needle.
What Does Cortisone Do?
Cortisone, also known as a corticosteroid or a steroid, is a hormone your body naturally produces via the adrenal glands. When delivered as a medication, corticosteroids reduce the activity of your immune system, which relieves inflammation and pain for people with different kinds of arthritis (as well as a wide range of other inflammatory diseases).
Corticosteroids comes in many different forms, which vary by how long they stay in your body, how easily they dissolve, and how quickly they take effect. They can either be delivered “locally” (in a specific location, like the knee or shoulder), or “systemically” (which means throughout the whole body). Systemic corticosteroids are usually taken orally (pills) or as injections (shots) into a vein or muscle. Local corticosteroids for arthritis can be given as an injection into a joint; for other types of health issues, they can also be delivered as skin creams, eye drops, or ear drops.
Why Would I Get a Cortisone Shot vs. Take Corticosteroid Pills?
Oral versions of corticosteroids are preferred to help control inflammation that affects multiple parts of your body, such as inflammatory forms of arthritis like rheumatoid arthritis. Pills may also be recommended if an area is difficult to inject, such as the spine or hip, says rheumatologist Paul Sufka, MD, of Health Partners in St. Paul, Minnesota. However, oral forms of corticosteroids can come with significant side effects and risks, such as elevated blood sugar and blood pressure, eye problems such as glaucoma, and increased risk of osteoporosis and infection, among others.
Corticosteroid injections, or steroid shots, can provide higher doses of medication to treat a specific problem area. According to Michael Schaefer, MD, director of musculoskeletal physical medicine & rehabilitation at the Cleveland Clinic in an article on their site, steroid injections are used most commonly for knee and shoulder pain, but they can be used for any joint in the body.
There are many different kinds of injected corticosteroids. According to data from the American College of Rheumatology, the most commonly used ones include methylprednisolone acetate, triamcinolone acetate, and triamcinolone acetonide.
Which Conditions Are Steroid Shots Used to Treat?
Cortisone shots can treat both inflammatory arthritis and osteoarthritis, but they may be more effective at treating inflammatory arthritis than osteoarthritis, according to the Mayo Clinic. “For osteoarthritis, sometimes people don’t get relief, and it’s hard to predict why,” says Dr. Sufka. In osteoarthritis patients with advanced disease, in which the cartilage in a joint is mostly worn away, it may be that the disease has progressed far enough along that the steroid injection isn’t effective.
No matter what type of arthritis you have, steroid shots are just one part of an overall treatment plan. For osteoarthritis, this could include NSAID medication, exercise and physical therapy, weight loss, and heat and ice therapy. For inflammatory arthritis, treatment includes disease-modifying drugs (from methotrexate to biologics) as well as those options. Steroid injections can help relieve inflammatory arthritis pain in the short term while longer-acting treatments like DMARDs have time to take effect.
“Treating joint pain usually involves multiple approaches,” according to Dr. Schaefer on the Cleveland Clinic’s site. “Depending on what condition is causing the pain, we try to find other long-term pain relief solutions through physical therapy, bracing, other medications or, in some cases, joint replacement.”
Where Are Steroid Injections Given?
It’s not like getting a flu shot, where you roll up your sleeve and present your arm. The steroid injection is given in the place where the pain radiates from. Locations such as the CMC (carpometacarpal and metacarpal bones at the base of the thumb), wrist, elbow, shoulder, knee, ankle, and big toe are common locations. For the spine and hip, doctors often use imaging, such as ultrasound for precise placement of the injection. This can help improve the accuracy of where the injection is placed, which can improve the effectiveness.
Does Getting a Cortisone Shot for Arthritis Hurt?
No doubt you’ve heard stories or have been warned that cortisone shots can be painful. Steroid shots are usually either mixed with a local anesthetic to help relieve pain or patients are given a local anesthetic first before the steroid shot is given. Some people feel minimal discomfort, while others feel intense pain; it’s hard to explain why injections hurt some and not others, says Dr. Sufka. One thing is certain: being anxious doesn’t help. “Many times pain comes from tensing up muscles around the needle,” he says. Dr. Sufka helps his patients his patients completely relax the area before the injection.
When Peggy Meyer, an osteoarthritis patient from North Carolina, was exploring her pain management options, she heard good and bad things about steroid shots but decided to go for it. “I recall how I dreaded those shots initially, but the few seconds of discomfort is worth the relief it brings,” Meyer says. “Now, when my knee tells me it’s time for another shot, and I actually look forward to it.”
Immediately icing the area after the injection can help relieve swelling and pain. You may feel fine right after the injection while the anesthetic is still effective, but as it wears off, you may actually feel pain that is worse than what you experienced before the procedure. This increased level of pain — remember, a needle was just injected into your body — should only last up to two days before things start to improve.
How Long Does the Pain Relief from a Cortisone Shot Last?
For some (lucky) patients, cortisone shots can bring immediate pain relief; for others, it can take a few days after the injection to start feeling improvements. According to Dr. Schaefer at the Cleveland Clinic, it can take up to a week for the cortisone to take effect. For others, the shots don’t seem to have a big impact on pain and other symptoms. The duration of time for which the shots can bring relief varies tremendously. For some patients, they only work for a few months; for others, a single injection can provide relief for a year or longer.
Any Precautions After Getting Steroid Shots for Arthritis?
Your doctor will likely recommend that you go easy on the affected joint for a few days after the steroid injection. If you got a shot in your knee, this means resting/elevating it when you can throughout the day. If you got a shot in your shoulder, you should avoid lifting heavy things. You should use ice on the area to help swelling go down, but not heat therapy. Here are more examples of how to use cold therapy for arthritis pain.
How Often Is It Safe to Get Steroid Shots?
There’s no universally approved number — and the frequency will depend to some extent on individual patient factors, such as extent of pain, other treatments received, overall health, comorbid conditions, etc. — but as a general rule, doctors limit the number of steroid injections you can get in a joint to no more than three to four a year. That’s because cortisone shots can cause side effects and, in some cases, even do more damage to the joint itself if given too frequently.
What Are the Main Side Effects of Steroid Injections?
Any medication has some tradeoffs with side effects, but overall, the risk of serious side effects with steroid shots for arthritis is low. Injected steroids for arthritis have a lower risk of side effects than oral corticosteroids.
Any time you get an injection, there’s a risk of infection, so it’s important to keep the area clean and avoid getting steroid injections if have an infection elsewhere in your body. Since an increase in pain is common after a steroid injection — sometimes called a postinjection flare — it’s important to be able to distinguish this from the signs of infection. The main things to look out for in the case of infection are: a pain flare lasts more than two days or begins more than two days after the injection; there’s redness or drainage around the injection site; and you also have fever or fatigue.
Other possible side effects of steroid shots include facial flushing, skin discoloration, local bleeding, or an allergic reaction. Cortisone shots can also raise your blood sugar in the short term, so they’re not recommended for people with diabetes whose blood sugar is poorly controlled.
Too-frequent injections in the same area can weaken the bones, ligaments, and tendons, which is why doctors limit how often you get steroid shots in a given joint.
“Some studies have shown that [steroid injections] can cause damage in tendons and may predispose people to tendon rupture,” according to Dr. Schaefer from the Cleveland Clinic. “I often remind patients that inflammation is also damaging to their joints, and cortisone actually prevents this damage. However, if patients rely on multiple cortisone injections just to cover up their pain, they may eventually wear out their joints prematurely.”
This is why, he adds, it’s important not to rely only on steroid injections for short-term pain relief but to also treat underlying contributions to arthritis pain, including losing weight, improving posture and body alignment, and taking disease-modifying drugs for inflammatory/autoimmune arthritis.
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