Cortisone Flares: Why There's Pain After a Steroid Shot

Woman with ice pack on knee
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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 and causes pain and/or inflammation around the injection site. Often, cortisone shots can provide rapid and lasting relief from symptoms of an inflammatory condition, but not everyone has a positive reaction to a cortisone shot.

Uses of Cortisone Injections

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, typically in the joints, such as tendonitis, bursitis, and arthritis.

Other Side Effects of Cortisone Shots

There are potential side effects of cortisone shots that can range from a minor annoyance to serious problems. These include:

  • Skin around the injection area becoming lighter or white
  • Skin and tissue around the injection area becoming thinner
  • Nerve damage
  • Blood sugar increasing temporarily
  • Infection in the joint
  • Bone that's near the injection area thinning or dying

Why Cortisone Flares Occur

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, which 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 to Treat a Cortisone Flare

    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 any strenuous activity.
    • Ice. 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 fairly quickly.
    • Anti-inflammatory medications. Nonsteroidal anti-inflammatory medications (NSAIDs) like Advil or Aleve are some of the most commonly prescribed medications for problems such as a cortisone flare. Check with your doctor to make sure it's safe for you to take these medications.

    Duration of Cortisone Flares

    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.

    Mayo Clinic. Cortisone shots: Risks. Published July 2, 2016.

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