Most people hear “steroids” and most will immediately think of some iron pumping, professional athlete-type, ‘roid rager with biceps the size of VW bugs. Most media coverage of steroids involves a lot of negative press, giving steroids which can be very helpful a bad name… and did I mention ‘roid rage?
Cortisone is a steroid, but it isn’t the sort that would make anyone bulk up, be the terminator, or hit home runs. Those sort are Anabolic or Androgenic steroids, they do not help with pain. Cortisone shots are a steroid hormone, also known as corticosteroid, and though there is sometimes other stuff in the shots, it is the important bit that makes them work. (The other stuff is generally saline, and local anesthetic.)
Believe it or not, your body naturally produces a certain amount of this already, it is made in the Adrenal glands, who besides the brain endocrine glands and the thyroid, is a huge part of keeping your body healthy and working right. Think of the endocrine system sort of like the internet, it is the system your body uses to send out signals and make sure that all the trillions of cells are all on the same page about what is going on, or can all act in unison if necessary. Like when your body says, “hey, I am sick” its all the things that make you feel that you are sick. That is your immune system, triggered by your endocrine system to respond to start fighting things, which is what makes you feel bad when you are sick. The cortisone produced by the body is produced when the body is stressed, and stress can occur if you are injured or in danger which triggers with the fight or flight response. So you are basically creating a large wash of those “we are in stress” chemicals, and this can have a great healing effect for some people, or at least the reduction of pain. It does also mean your body is in an unnatural state and that can have some side effects.
Cortisone was discovered in the 1940’s by two guys from the Mayo Clinic, it was hailed as a miracle drug (aren’t they always?) and was the reason the discoverer’s got a Nobel Prize in the 50’s. There are now a plethora of drugs that are corticosteroids such as but not limited to, (and these are just their names, not commercial names) prednisone, methylprednisolone, prednisolone, dexamethasone, and the well known hydrocortisone. There are many ways to take corticosteroids, orally, topically, injection, and inhalers are a few ways. I am generally talking about cortisone products used to treat pain though in this entry, and they are usually injected into the body.
In a lot of ways cortisone was a miracle drug, it helps ease chronic pain, pain from injuries, it treats autoimmune diseases, it helps with organ transplants preventing rejection, and many, many other ailments. Most of the cortisone injected is synthetic but still chemically similar to the natural thing, and it works pretty much the same as the natural stuff, just in larger amounts. It works because it helps to suppress the body’s natural immune response, that is how this great drug helps to inhibit rejection in someone with a newly transplanted organ. This suppression means though, you need to be very careful about your immune system. It can cause other issues that I will discuss further down in this post, but that is the biggest one I have had to battle with.
Inflammation is your body’s natural healing response, but sometimes that signal is sent in error, or is sent too much, and pain happens. Cortisone helps to reduce that inflammation, and alleviate some of that pain. Now that is not to say when you receive an injection (which is generally how my pain is treated) it will be instant pain relief. You are putting a needle into a site that is already irritated, and just generally pretty upset with things if you are in pain. Then you are injecting fluid into that area, which will create artificial swelling of that area. The swelling is very small, you wouldn’t notice it externally, but small is all that is needed for a nerve to notice. So an injection can actually put you in more pain than when you started, but believe me, it is all so very worth it if it works. Especially since the pain generally only lasts a few days.
Now, the skill of the doctor is also a big part of this pain levels post-procedure. I have had some pain doctors who are just absolutely horrible, they will just poke you anywhere, and not care if you complain. Or that you are in far more pain than before the injection. I had one that was attempting to alleviate neck pain, and I spent the next 3 days wondering if I really could cut my own arm off, since that was better than living with how it felt after the injection. My arm eventually became sort of normal again, after a few months luckily. But it has become a huge issue since then. My current pain doctor is much more precise and uses fluoroscopy, and other tools to be sure of where she is “poking” me. I find with her more precise methods I not only rarely experience post-procedure pain, but also have better results with my pain reducing. That is not to say I don’t have occasionally mild injection site soreness, like I said, poking already upset areas, but it is far less than what I have experienced at the hands of others. Normally if you are in pain after the procedure you can rest assured that it will probably only be the worst the day after, lessening the second day and nearly gone by the third. If you don’t find your pain reducing after the third day, you really need to be talking to your doctor. That third day should be the day that you will see exactly what the procedure accomplished, and for me they have usually been good results.
There are also many names that these sorts of injections go by which can make it confusing, and that doesn’t mean they’re in the same places for everyone or the same amounts of steroids. But you should be aware of what is being put in you with each procedure, and below are some informative videos to start you off on what some of the ones I have experienced over the years. If you are interested in some more great videos on common procedures, see the video link at the end of this entry. If you are afraid of needles, probably should avoid all these videos.
Trigger Point Injections – I generally get these as a quick fix to hold me over until we can schedule a procedure.
Nerve Block(er) Injection – these have brought a lot of relief for a lot of different symptoms, I suggest using a pain clinic that has your pain doctor injecting these rather than just a radiologist (one should still be present for the procedure though).
Sympathetic Nerve Block – not to be confused with the above, this is different. I find this helps me the most with my CRPS issues with neurological pain. Definitely not a video for the squeamish about needles.
Now for the sorta scary bit. This is where I list all the things that can go wrong from cortisone injections (or general corticosteroid use). Side effects to getting these injections can be the following (with some of my own tips):
- Change in your body’s response to stress – we already said that cortisone is part of the fight or flight response, which is a body’s response to stress. Obviously if you pump your body full of chemicals that are there during stress, it throws things off. You really need to be mindful that just like if you have thyroid issues and take thyroid medication the actual gland can go “well, my work here is done” and just turn off. Your adrenal glands can do something similar and this can last for up to a year after the injections. You may find that you get light headed, or aren’t able to deal with sudden surprises or stresses, make sure you recognize when you are getting stressed and do all you can to soothe and calm your body so that it does not reach an overly stressed state. Also let other doctors know you have had corticosteroids so they can compensate if necessary in any non-pain procedures.
- Hoarseness – yeah, it can make your throat dry, and make your voice raspy. I do a lot of hot teas with honey and lemon, and occasionally break down and buy over the counter throat lozenges to help with this. Water is a big deal after these injections. Hydrate, hydrate, hydrate. It helps.
- Infection/Illness – Skin is breached with injections, and any scrape or cut from a fall or kitchen accident could become infected. We already know the immune system is suppressed so that means the natural responses to fight off even things like a paper-cut are not present. Make sure you take extra care with cuts and abrasions, take them all seriously and monitor them. If the skin around them becomes red, inflamed and tender, you may have to deal with an infection through medical means. Seek a doctor if something like that happens. This is also true for colds, flus, and everything else you can catch. Wear a mask if you can when going out, and try to avoid sick people. Also make sure you are getting sleep, taking vitamins, and doing all you can daily to boost that immune system.
- Osteoporosis – this for women is the biggest danger, I discovered recently that I was having issues with calcium as well as other vitamin deficiency. Cortisone breaks down a lot of the stuff our body uses to work, or makes those chemicals harder to take up, make extra sure you are compensating for this, and doing strength exercises to ensure that there is no bone loss. You really need to worry about this if you are like me, and getting a lot of these over a long period of time. If you get a few and then no more, not as big a deal.
- Weight Gain/Fluid Retention – UGH, I hate this one! Cortisone makes me ravenous sometimes, like eat the entire fridge and still hungry type craving for food. This is something you just have to be stern with yourself and fight, but it does make that fight just the bit harder. About six months after the steroid use you should see a decrease in the weight, and if you are careful while you are getting these injections you shouldn’t see excessive gain. Just be mindful, watch what you eat, get exercise just like normal. High sodium diets also cause water retention, check for swelling and if you find it (and its not weight gain) make sure you speak with your doctor.
- Mood Changes & Insomnia – Hey, we all have bad days, right? But make sure that bad day isn’t one you decided is bad before things even happen. Look at your mood and assess it, is this really how I feel? Do I normally react like this to these sorts of things? If the answer is no, think about what “flipped that bitch switch” as I like to say. Make sure you are doing all you can to keep a positive happy outlook on things, yoga, meditation, tai chi, all of those are great ways to help combat all mood issues this and everything else that comes with pain causes. It can also make you have issues with sleeping, but when you are in pain you don’t sleep anyway. I suggest for this, natural sleep aids, I have discussed a few but there are tons out there I still haven’t covered yet. Find what works best for you on both of these and use it!
- Elevated Blood Sugar – this is a definitely possible side effect if you are like me and getting these a lot, over a long period of time, and could lead to diabetes. Watch your weight and always look for signs of diabetes. Diabetes is not a fun thing to have so keep and eye on this, check out the ADA site, and make sure you aren’t at risk. No one wants to have the diabetes!
- Atherosclerosis – a big word that means basically your walls of your arteries getting hard. It puts you at risk for heart disease and other circulatory issues. If you are smart and are living a healthy lifestyle, this probably won’t even be an issue. Others, not following that, well you might get it anyway? Why tempt fate?
- Aseptic Necrosis – this is by far the scariest thing in this list. This can happen and it is not pleasant, it means parts of your bones are dying inside you. Which is the stuff of nightmares to be sure! The most vulnerable place for this issue is the hip joint, which is less the side of your body and more your groin area. So if you are getting injections close to your hip, monitor pain in your groin area and if you have any, get to a doctor quick fast. You can get this in other places but it is pretty rare, and is accompanied by pain, most of the time.
I have mentioned a lot in my posts that I frequently get injections to help with pain, and that if you are getting these regularly make sure you are taking all your vitamins, and take care of your immune system. I have them a lot, probably more than is really good for my body according to a lot of information, but its down to a matter of quality of life. More injections and I can move, have less pain, and basically live life. Less injections, and it is back to the cane and being trapped in my own immobile hurting shell. Frankly, it becomes for me one of those “damn the consequences” sort of things. I do wish that there were other ways, I have attempted many things, and am always looking for new avenues, but these really allow me to remain a functional human until that other treatment can be found. Others, depending on the level of pain you are in, and your specific condition may not need as aggressive treatments.
Not everyone reacts well to cortisone, and some patients not at all. Cortisone should also never be your first option, only after doing physical therapy, chiropractic, stretching, diet/weight loss, and all the other avenues available, besides surgery, should you consider getting a cortisone injection as that last thing before you decide on surgery. Don’t let that scare you off if you need it, but don’t make it your go to solution, unless you have to. Look at your situation, discuss it with your doctors and make sure you educate yourself on some of available treatment options, and the issues cortisone can cause for your specific issues.
For the videos I mentioned earlier that give a great explanation on all sorts of steroidal injections used for back pain, or other back/nerve related pain go here.
Remember, I am not a medical doctor so your professionals should be guiding you and helping you make your decisions. But don’t ever trust their word completely, look up what is being done, make sure you are familiar. Educate yourself as much as possible, no one will do it for you!