CORTISONE SHOTS: IS THERE A LIMIT?

cortisone injection

CORTISONE SHOTS: IS THERE A LIMIT?
Stephanie McClain Riddle PharmD

Physicians generally limit the number of cortisone injections a patient may receive. Often physicians guide their patients to no more than three or four injections per year, a maximum of three injections total, no more frequently than every six weeks, or other limitations, depending on factors such as the effectiveness of previous injections, joint health, other medical problems, and the injection site.

For many patients, the benefit of pain relief and improved mobility, even though it may be temporary, far outweighs the risks of repeated cortisone injections, but there are risks. Understanding those risks helps you, and your physician, to determine the best course of your treatment.

Cortisol is naturally occurring in the human body, made by the adrenal gland, and is released into the bloodstream when the body is under some type of stress. But the effects of naturally released cortisol last for a short time, perhaps only a few minutes. Injectable cortisone is made synthetically to mimic the effects of naturally produced cortisol, but the effects last much longer since the drug can be injected directly into the joint where the inflammation, and therefore the pain, is occurring.

Cortisone injections into joint areas are a safe and very effective way of treating painful conditions by reducing the inflammation that is occurring inside and around the joint. Although the risks of side effects associated with cortisone injections are small, understanding those risks can help you and your physician proceed with the safest and most effective form of treatment for your condition.

According to information provided by the Mayo Clinic, cortisone shots have been associated with complications such as osteonecrosis, meaning death of bone near the injection site, joint infections, nerve damage, thinning of skin and soft tissue around the injection site, tendon weakness or rupture, osteoporosis, meaning thinning of nearby bone, whitening or lightened areas of the skin around the injection site, and possibly a temporary flare of pain and inflammation in the joint. Repeated injections have caused concern for deterioration of the cartilage within the joint.

The cortisone from the injection sometimes gets into the systemic circulation in small amounts. This can cause elevated blood sugars, facial flushing or a warm feeling in the chest, blood pressure fluctuations, and may interfere with some medications such as blood thinners. Menstrual irregularities in women have also been reported after receiving cortisone injections.

Physicians limit the number of cortisone shots into a joint in order to avoid damage to cartilage, tendons, and to overall maintain the health of the joint area. Be sure your physician is aware of your medications and any medical problems you may have, and the effectiveness of any previous cortisone injections to the same joint area. Know the risks and benefits of repeated cortisone injections, and ask your physician if you have any questions or concerns.

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