Injection therapy: Relieving pain at the source

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Cortisone shots: Relieve joint pain at the source

Cortisone shots help relieve joint pain, but may cause side effects.

If your pain is mostly in one particular spot, such as in a joint or a trigger point in a specific muscle, your doctor may suggest injecting medication right into the site of your pain. These injections are commonly referred to as cortisone shots, but what medication is injected can vary.

Joint injections are usually a combination of a local anesthetic, or numbing agent, which provides immediate relief, and a corticosteroid, such as cortisone. The steroid reduces inflammation and often can relieve your pain for several weeks or even months at a time.

Before turning to cortisone shots, however, doctors usually try less invasive treatment methods first — such as oral medications and physical therapy.

Who may benefit from cortisone shots?

Cortisone shots are most often used if you have:

  • Osteoarthritis. This wear-and-tear type of arthritis most commonly affects joints in the hands, hips, knees, neck and lower back.
  • Rheumatoid arthritis. An inflammatory disorder that occurs when the body is attacked by its own immune system, rheumatoid arthritis can affect some organs as well as joints. Joint deformities are common.
  • Trigger points. Repetitive stress on a specific muscle can lead to trigger points — hard, painful knots located in taut bands of muscle. Common sites include the neck, shoulder and hip.
  • Tendinitis. Tendons are the thick, fibrous cords that attach muscles to bone. Tendinitis is inflammation or irritation of a tendon and is typically caused by overuse. The most common sites are shoulders, wrists, heels and elbows.
  • Bursitis. Bursae are fluid-filled pads located throughout the body that lubricate places where tendons or muscles pass over bony projections. Inflammation of a bursa is called bursitis, which most often occurs in shoulders, knees, elbows and hips.

How do you prepare for a cortisone shot?

Usually no special preparation is necessary, although your doctor may ask you to refrain from taking any blood-thinning medications for a few days before the procedure, to reduce your chances of bleeding.

How are cortisone shots given?

Proper placement of the cortisone shot is crucial, but it can be difficult. There are many different structures around a joint that can cause pain. Is there a torn tendon? An inflamed bursa? Or damaged cartilage from arthritis? Each of these problems requires the cortisone shot to be placed in a specific location.

The numbing agent included in most joint injections serves two purposes. In addition to making the injection itself less painful, the anesthetic can help verify proper placement of the needle. Your immediate relief of pain indicates the needle is in the right place.

A variety of substances have been used in trigger-point injections, including numbing agents, botulinum toxin (Botox), corticosteroids and other anti-inflammatory drugs. In some cases, pain relief occurs simply from the physical piercing of a trigger point with a needle — even when no medicine is injected.

What can you expect during the cortisone shot procedure?

The cortisone shot can be done in your doctor's office. Depending on the location of your pain, you will recline or sit in a way that allows the nearby muscles to be as relaxed as possible. Your skin may be numbed, but the injection itself may still be uncomfortable.

In trigger-point injections, you may feel a sharp pain or muscle twitching when the needle hits the knotted muscle. Your doctor may adjust the needle position and inject medicine into the knot from several different angles.

The anesthetic in the injection wears off within a few hours, and the corticosteroid usually takes a few days before it starts to work. In between, your injection site may be a little sore and swollen. An ice pack can help relieve those symptoms.

However, if these symptoms last longer or begin later than 48 hours after the injection or are associated with fever or chills, you may have an infection. A joint infection following a cortisone shot is an uncommon complication, but it can become a very serious problem, requiring surgical drainage.

Results of cortisone shots

Cortisone shots into joints or trigger points can provide pain relief for months at a time. Often this period of pain relief can provide an opportunity to make progress with your physical therapy and rehabilitation goals. Even though the pain may be gone, continue to follow your doctor's instructions so that the area can heal properly.

Risks of cortisone shots

Complications of cortisone shots are rare, but can be serious. If the injection introduces bacteria, an infection can occur. Delayed treatment for a joint infection can destroy the joint's function.

Signs of an infection include:

  • Fever of at least 100.4 F
  • Injection site becomes red, swollen, tender or warm
  • Fluid drains from injection site
  • Injection site drainage has an odor

If corticosteroids are injected directly into tendons or nerves, it can cause severe damage. Color changes also may occur around injection sites in people with dark skin. Soft tissues around the injection site may shrink (atrophy).

Corticosteroids can also weaken bones and make you more prone to cataracts. Serious side effects more typically occur in people who are taking corticosteroid pills daily for long periods of time. Pills affect the entire body, while corticosteroid injections tend to work primarily at the injection site.

Still, doctors usually limit the number of corticosteroid injections you can receive within a given time period. Many doctors limit the number of cortisone shots you may receive to three or four a year. If you feel that you need more frequent cortisone shots, talk to your doctor about other ways to control your pain. If you're currently taking other medications for arthritis pain, these may need to be adjusted to help you better control your joint pain.

Last Updated: 11/17/2006
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