If you are suffering from joint pain or inflammation that is not responding to other treatments, your doctor may recommend a cortisone shot. Cortisone shots contain a steroid medication that provides fast relief by reducing inflammation in the joint. However, cortisone shots come with potential side effects and risks. Many people are looking for alternatives that provide similar anti-inflammatory benefits without the downsides of cortisone.
What are cortisone shots?
Cortisone shots contain a corticosteroid medication and a local anesthetic. The shots are directly injected into swollen, painful joints such as knees, shoulders, elbows, wrists, and hands. Cortisone shots provide fast relief by reducing inflammation in the joint which decreases pain and swelling.
Cortisone shots are often used to treat conditions such as:
- Osteoarthritis
- Rheumatoid arthritis
- Bursitis
- Tendinitis
- Carpal tunnel syndrome
- Trigger finger
- Plantar fasciitis
The anti-inflammatory effects of the corticosteroid medication begin working within a few hours to provide immediate pain relief. The benefits of a single cortisone shot can last for several weeks or months before wearing off.
What are the potential side effects of cortisone shots?
While cortisone shots can provide rapid relief for inflamed joints, they do come with some potential side effects and risks including:
- Increased pain – Some people experience a flare-up of pain in the joint for the first 24-48 hours before experiencing relief.
- Infection – There is a slight risk of introducing infection into the joint when it is punctured with a needle.
- Nerve damage – Hitting a nerve while administering the injection can cause temporary or permanent nerve damage.
- Tissue damage – Repeated cortisone injections in the same area could break down cartilage and other joint tissues.
- Weakening of bone and tendons – Frequent use of cortisone shots may lead to deterioration of bone and tendons near the injection site.
- Thinning of skin – Cortisone injections can cause the skin near the injection site to become thinner.
Cortisone shots are not recommended for people with certain conditions including diabetes, infections, bleeding disorders, and unstable joints vulnerable to fractures. Care must also be taken when getting cortisone shots during pregnancy.
What are the alternatives to cortisone shots?
There are several alternatives that can provide similar anti-inflammatory and pain-relieving benefits as cortisone shots minus the potential side effects:
Oral NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), and diclofenac (Voltaren) can help reduce inflammation and relieve pain when taken orally. NSAIDs come in both over-the-counter and prescription strengths.
Topical NSAIDs
Topical NSAID creams, gels, and patches allow the medication to be absorbed directly through the skin into the painful joint. Topical diclofenac (Voltaren gel) is an NSAID often used to treat joint pains. Topicals help limit systemic exposure to NSAIDs.
Acetaminophen
Acetaminophen (Tylenol) can be very effective at relieving joint pain, even though it does not reduce inflammation. Acetaminophen has fewer side effects than NSAIDs and is generally safe for most people when taken as directed.
Heat and cold therapy
Applying heat or cold to the painful joint can help relieve pain and inflammation without medication. Heat therapy increases blood flow and relaxes muscle spasms. Cold therapy numbs nerves and constricts blood vessels to reduce swelling and inflammation.
Compression
Wrapping the joint with an elastic bandage or supportive brace can compress and stabilize the joint to provide pain relief. Compression limits swelling and provides added joint support.
Exercise
Certain low-impact exercises can help strengthen muscles around the joint to provide added support and reduce pain. Exercises that increase flexibility and range of motion can also help relieve joint pain.
Physical therapy
Working with a physical therapist can help determine exercises tailored to improving flexibility and strength in the painful joint. Hands-on techniques such as massage and joint mobilization performed by a therapist can also help.
Alternative medicine
Alternative treatments like acupuncture, massage, chiropractic adjustments, and nutritional supplements may help relieve joint pain for some people. More research is needed to confirm effectiveness.
Joint injections
Injections that don’t contain corticosteroids may provide pain relief without the side effects. Options include:
- Hyaluronic acid – Occasionally injected into the knee to treat osteoarthritis pain.
- Platelet-rich plasma (PRP) – Injected PRP contains concentrated growth factors that may help reduce inflammation and promote healing.
- Amniotic fluid – Contains healing and anti-inflammatory elements that may provide pain relief when injected into joints.
When should you get a cortisone shot vs trying alternatives?
Here are some guidelines on when a cortisone shot may be preferable to trying alternative treatments first:
- You need very quick relief – Cortisone starts working within hours while some alternatives can take weeks to have an effect.
- The joint pain is severe – A cortisone shot may provide faster, more complete relief from intense pain.
- Inflammation is very high – Cortisone is the fastest way to reduce significant inflammation.
- You have tried other options unsuccessfuly – If alternatives like NSAIDs, ice, or exercise haven’t worked, a cortisone shot may still help.
- The joint pain is limiting mobility – Cortisone can rapidly improve range of motion and function.
However, for milder joint pain, trying safer alternatives first for a few weeks to see if they provide adequate relief is recommended. Cortisone shots come with risks that make them unsuitable for long-term use. Using cortisone sparingly and relying on other anti-inflammatory treatments when possible is ideal.
Conclusion
Cortisone shots are a fast-acting treatment for painful, inflamed joints. However, potential side effects make them unsuitable for frequent use. Safer anti-inflammatory alternatives like NSAIDs, compression, ice, and exercise should be tried first when possible. However, for severe, debilitating joint pain that has not responded to other conservative treatments, a cortisone shot may provide the quickest route to relief. Working with your doctor to weigh up the pros and cons will help determine if a cortisone shot or alternative therapy is right for your specific condition.
| Treatment | Benefits | Risks/Side Effects |
|---|---|---|
| Cortisone shots |
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| Oral NSAIDs |
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| Topical NSAIDs |
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| Heat/Ice therapy |
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