Injections as a treatment option
Injections are often used for the treatment of pain. The most frequently used injection is a Cortisone injection, also called a steroid shot. Other injections are also used for the treatment of pain.
With a careful assessment of the benefits, cortisone is a very useful and effective tool in any orthopaedic practice. Cortisone injections are used to treat inflammation caused by many common orthopedic problems.
What is Cortisone?
Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting.
Injectable Cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body’s own product. The most significant differences are that synthetic Cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic Cortisone is designed to act more potently and for a longer period of time (days instead of minutes).
How does the Cortisone injection help?
Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from Cortisone it is because the inflammation is diminished. Cortisone injections usually work within a few days, and the effects can last up to several weeks.
Many conditions where inflammation is an underlying problem are amenable to cortisone shots. These include, but are certainly not limited to:
- Shoulder Bursitis
- Arthritis – knee, ankle and hip
- Trigger Finger
- Tennis Elbow
- Carpal Tunnel Syndrome
- Knee, Ankle and Hip Pain
Does the cortisone injection hurt?
The shot can be slightly painful, especially when given into a joint, but in skilled hands it usually is well-tolerated. Numbing medication is often injected with the Cortisone to provide temporary relief of the affected area. Also, topical anesthetics can help numb the skin in an area being injected.
Probably the most common side-effect is a ‘Cortisone flare,’ a condition where the injected Cortisone crystallizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given.
Can I get a Cortisone injection more than once?
Yes. The rule is dependent upon the response to pain relief that the patient gets from injections. The typical number given in a year is approximately 3-4 if pain relief means these type of injections are referred out to a pain specialist.
Epidural Steroid Injections
Epidural steroid injections are an option for the treatment of back pain and inflammation around the spinal nerves. An epidural steroid injection is performed using an x-ray to guide the medication to the area adjacent to the inflamed spinal nerve.
The epidural steroid injection lasts about 15 minutes, and light sedation may be used if needed. Usually a series of injections, often three, each spaced a week apart, are given. With this schedule, many patients find relief of symptoms within a few weeks. Often this helps control the inflammatory process and may provide long-lasting relief.
Viscosupplementation is a term used to describe a series of “lubrication” injections administered once a week for 3-5 weeks consecutively, depending on the manufacturer. These injections have been approved in the United States since 1997. The active ingredient within all of the medications is hyaluronic acid which is a building block of our joint cartilage and our joint (synovial) fluid. Normal joint fluid is fairly viscous (thick like cooking oil) as compared to the fluid in an arthritic knee which loses its viscosity and elasticity, becoming more water-like.
The injections are believed to work by several mechanisms. The medication is designed to repeatedly stimulate the joint lining to produce joint fluid with better viscous properties. It typically takes two to three weeks after the first injections to notice a difference in pain and the the maximum level of relief occurs at around week 4 or 6. The relief from the injections will last on average about six months and sometimes longer. The injections may be repeated every six months if needed and can be used indefinitely. The most common side effect is injection site pain which usually subsides within 24 hours.