Steroid injection (cortisol shot) – what you should know?

In our country people usually refer to this as a "steroid injection," while Anglo-Saxon physicians use the term "cortisol shot." The injection solution typically contains a drug from the corticosteroid group and a local anesthetic. The main effect of cortisone is to reduce the body's immune response and rapidly decrease joint complaints. For this reason some doctors (and of course inadequately informed patients) like it so much that the injection is often given at the first doctor-patient encounter.

However, steroid is not only a friend! Read this article of mine.

Because of possible side effects, the number of steroid treatments that can be given within one year is limited. Steroids have many negative side effects that you should be aware of. A bigger problem, however, is that in a large number of cases suppressing the natural immune process can mean the disease does not heal immediately, becomes persistent (chronic), and may even worsen in the long term.

What is it used for?

Cortisone injections can be most effective in treating inflammatory joint disease, such as rheumatoid arthritis. They can also be part of the treatment for other conditions, including:

• Back pain
• Gout
• Osteoarthritis (degenerative cartilage disease)
• Psoriatic arthritis (arthritis due to psoriasis)
• Reactive arthritis
• Tendinitis
• Tenosynovitis

Risks

A single injection usually does not have permanent effects. The larger the dose and the more frequently injections are given, the greater the risk and severity of side effects. Side effects may include:

• avascular necrosis (death) of nearby bones
• joint infection (due to improper administration)
• nerve damage
• temporary flushing of the face
• temporary increase in pain and inflammation flare-up in the joint
• a temporary rise in blood sugar
• weakening of a tendon, even rupture
• thinning of nearby bones (osteopenia/osteoporosis)
• thinning of the skin and soft tissues around the injection site
• whitening or lightening of the skin around the injection site

As mentioned, cortisone inhibits the immune system. The immune system's job is to overcome inflammation and infections. This means that while on steroid treatment your protection against infections is reduced. Steroid treatment is not recommended if any of the following infections are present:

• fungal infection
• viral infection
• bacterial infection

Only in limited quantities!

Current data indicate that repeated cortisone injections may damage joint cartilage. Therefore the number of cortisone injections into a joint should be limited.

In general, the medication can be given again after 6 weeks and usually no more than three to four times per year (this, of course, also depends on the specific preparation).

Cortisone is a powerful medication and can provide rapid relief to the patient, but you must think long term and, because of possible negative side effects, try to use as little steroid as possible.

Particular caution is required if any of the following conditions already exist:

• Osteoporosis: cortisone accelerates bone tissue loss and worsens the structure of thinned bone.
• Diabetes: even a single injection can raise blood sugar levels; regular steroid exposure can lead to the development of diabetes.
• High blood pressure and heart disease: research has shown steroids increase the risk of cardiovascular disease, including heart attack, heart failure and stroke.
• Pregnancy, breastfeeding: it can harm the fetus and may be transferred into breast milk during breastfeeding.
• Liver disease.
• Gastrointestinal disorders (including ulcerative colitis and other ulcers).
• Muscle diseases.
• Kidney disease.

Administering the steroid injection

If you take blood thinners, tell your doctor before receiving a cortisone injection, because bleeding or bruising may occur at the injection site. Some dietary supplements also have blood-thinning effects. Ask your treating physician which medications and supplements you should avoid before receiving a cortisone injection.

Inform the doctor if you have had a "cold" or a fever of 38 °C (100.4 °F) or higher in the past two weeks.

The injection itself is performed much like any other injection. The skin around the injection site is cleaned. In larger clinics the needle's progress through your tissues may be monitored with ultrasound or another imaging method to ensure the needle is placed in the correct location.

Immediate effects after cortisone administration

Some people experience flushing and warmth in the chest and face. If you have diabetes, your blood sugar may rise temporarily.

Protect the injected area for one or two days. For example, if you received it in your shoulder, avoid lifting heavy objects; if in your knee, try not to stand for long periods and especially avoid running or jogging.

If the injection area is tender, apply ice to the area, but do not use a heating pad.

For 1–2 days only shower; do not sit in a bathtub or visit a public bath/spa.

Watch for signs of infection. If the injection site is still painful, swollen and red after 48 hours, notify your doctor as soon as possible.

Cortison shot or physiotherapy?

Treatment outcomes generally depend on the reason for therapy. There are conditions and problems that respond very well to this type of treatment — primarily bursitis and mucositis.

The steroid spreads around the injection site. Because the cortisone injection usually also contains a painkiller, your symptoms may ease immediately. But this is not a cure — the drug merely "blows away" the symptom.

A temporary flare-up of pain and inflammation can be observed after the injection for up to 48 hours. After that, pain and inflammation in the affected joint usually decrease, and this favorable state can last for several months.

Several studies have compared the effects of physiotherapy and cortisone injections.

The cortisone injection showed greater improvement at 6 weeks (i.e., short-term) than physiotherapeutic methods.
However, the situation reversed in the long term. At the 12-month follow-up, those who received steroids had a significantly higher frequency of recurring problems, pain and dysfunction.

It is very important to understand that despite its short-term beneficial effects, cortisone injection is not a lasting solution — indeed, this is its main risk.

Cortisone is beneficial in the short term, which makes the patient believe everything is fine. In reality there is a greater risk that the condition will worsen in the long term.

So why are steroids still given?

A person tormented by pain wants to get rid of it as soon as possible. The effects of physiotherapy usually develop slowly, over weeks, meaning the patient experiences only modest improvement for some time. The patient receiving physiotherapy therefore becomes impatient and returns to the doctor.

The doctor often "doesn't like" a patient who regularly returns and complains, so the steroid is quickly brought out. The complaints ease, but because this is not healing — only a kind of "trick" — they will return. It's only a matter of time.

See my article "Why aren't you healing at the expected rate?".

The most effective treatment is a combination of the right lifestyle and physiotherapy. However, this does not produce immediate results. Improvement can be significantly delayed depending on the problem.

Individualized exercise programs, eccentric training, anti-inflammatory modalities (therapeutic ultrasound, softlaser, microcurrent, pulsed electromagnetic field, etc.), accelerating the recovery of muscle strength with muscle stimulators — all these methods support the body's regenerative processes and lead to real improvement.

However, this can take 2–3 months and maintaining the favorable state requires further effort.

The steroid injection gives an immediate result without effort... it's enough to think short term and not consider the future. This is called the head-in-the-sand policy.

Frequently asked question

Diprophos (betamethasone) is a steroid-based medication primarily used to treat inflammations and allergic reactions. The active ingredient in the preparation appears in two different forms: one component, betamethasone sodium phosphate, exerts its effect immediately, while the other component, betamethasone dipropionate, is released gradually to provide a sustained therapeutic effect.

After administration, the sodium phosphate derivative reaches peak concentration in the blood within a few hours, providing immediate symptom relief. After that the dipropionate form becomes active, exerting its effect over a longer period.

A significant portion of the active substance is eliminated from the body within 14–21 days, however the therapeutic effect can last for a different period of time independent of this elimination.

The duration of treatment effectiveness depends on many factors: the dose given, the site of application, the nature and severity of the disease being treated, and individual bodily responses.

The anti-inflammatory and analgesic effect is typically noticeable for several days, sometimes weeks. In the case of arthritis, for example, symptom relief can persist for several weeks.

Various unwanted effects may occur during therapy, such as muscle weakness, decreased bone density, elevated blood pressure or increased blood glucose levels, as well as skin lightening at the injection site.