Cortisone Flare - Worsing Pain After a Steroid Shot

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A cortisone flare is a reaction to a cortisone injection. Usually, this "flare reaction" is experienced shortly after the injection, typically within 24 to 48 hours.

Cortisone injections are a commonly used treatment by orthopedic surgeons and other physicians.  Cortisone is a powerful anti-inflammatory medication that can be used for a broad array of orthopedic ailments from tendonitis, bursitis, and arthritis.

  Often cortisone shots can provide rapid and lasting relief from symptoms of an inflammatory condition.  However, not everyone has a positive reaction to a cortisone shot!

There are side-effects of cortisone shots that can range from minor annoyance to serious problems.  One of the most common side-effects of cortisone shots is called a cortisone flare reaction.

What Causes a Cortisone Flare?

There are two causes of a cortisone flare:

  • Needle Puncture
    Placing a needle through the skin causes an injury to the body. Your body may react to this needle injury with inflammation and pain.
  • Crystallization
    Injected cortisone can form crystals, and these can irritate the soft tissues, including the lining of joints (the synovial tissue). This tissue can become inflamed, causing a reaction called crystalline synovitis.

How Can a Cortisone Flare be Treated?

The best treatments for a cortisone flare are:

  • Rest
    The first recommended treatment is resting the area injected with cortisone to allow the inflammation to subside. This is usually accomplished by simply not engaging the body part in strenuous activity.
  • Ice the Area
    Apply an ice pack to the area, off and on, for the first few days. Knowing how to ice the area properly will help you along the way.  Ice is probably the most effective treatment for a cortisone flare, and will often make the symptoms subside quite rapidly.
  • Anti-Inflammatory Medications
    Nonsteroidal anti-inflammatory medications (NSAIDs) are some of the most commonly prescribed medications for problems such as a cortisone flare.  Check with your doctor if it is safe for you to takes these medications that are often very helpful at controlling symptoms of a flare.

    Will The Flare Stop?

    Cortisone flare reactions are almost always limited in their response.  Typically within a few hours or days the flare reaction will begin to subside, especially when the cortisone medication begins to have its effects on reducing inflammation. 

    If the pain continues to worsen despite the above treatments, you should contact your doctor.  Many patients who seem prone to developing these flare reactions will choose not to have cortisone injections for treatment of inflammation in the future, so if you do have this response you should let your doctor know.

    Sources:

    Johnson JE, Klein SE, Putnam RM. "Corticosteroid injections in the treatment of foot & ankle disorders: an AOFAS survey" Foot Ankle Int. 2011 Apr;32(4):394-9.

    Cole BJ and Schumacher HR "Injectable Corticosteroids in Modern Practice" J. Am. Acad. Ortho. Surg., January/February 2005; 13: 37 - 46.

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