The problems with cortisone shots

Posted on August 8, 2011

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cortizone shot

Cortisone shots suck.

Unless you are a high level athlete where returning to the playing field is critical to you, taking cortisone shots for joint pain absolutely, positively sucks.

Say your shoulder has been bothering you for 6 months, you walk into your primary care doctor and they do some asinine examination on your shoulder acting like they know what the hell they’re doing,

The doctor says you have tons of inflammation based on your pain levels, and recommends a cortisone injection. You ask what that’s for, they tell you, “to reduce the inflammation.”

First off, most people are prescribed a cortisone injection for some type of chronic pain they are suffering. The first issue with this is not all people suffering from chronic joint pain are experiencing inflammation. In fact, most chronic joint pain is from tendinosis, not tendonitis.

“Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.

From: http://bjsm.bmj.com/content/36/6/392.long

That is, the pain is due to chronic degradation of the tendon (-osis), not chronic inflammation (-itis). Chronic inflammation with joints is actually pretty rare as the inflammatory response is much more common in a traumatic injury during the acute stage.

In other words, considering your shoulder has been bothering you for 6 months or longer, you are no longer in the acute stages of an injury. You may not have ever had an acute stage to begin with. Typically the pain just slowly starts and gets worse and worse.

This is why some people get a cortisone shot and don’t notice any difference in their pain: they never had any inflammatory issues to begin with.

But what about those who do get pain relief? They’re even more screwed.

While the cortisone will get rid of the inflammation, which will then get rid of the pain, the cortisone isn’t getting rid of what’s causing the inflammation.

For example, say someone has poor posture so they experience shoulder pain when lifting their arm(s) overhead due to excessive impingement. The cortisone isn’t helping correct their posture, so it’s not preventing the excessive impingement, thus it’s not helping what’s causing the pain, it’s only treating the symptom.

In fact, in the long-term it’s going to make things worse. Pain is a survival tactic by the body and joint pain is a sign that you are damaging the joint, so it causes you to stop what you’re doing, as you obviously don’t enjoy the pain.

Due to the effects of the cortisone though, you can no longer feel the pain. But that doesn’t mean you’re not still damaging the joint when you’re lifting your arm overhead. Again, your posture is still bad and you’re still experiencing that excessive impingement. It just doesn’t feel as bad as it used to.

This is why you see some people get a cortisone shot and 6 weeks later, or whenever that shot starts to wear off, they feel worse.

Furthermore, when you are trying to get someone out of pain you use pain as a guide as to when they should stop a movement or as to when they’ve become too fatigued. It serves as a guide as to whether the treatment prescribed is working or not. If the person can’t feel pain in the joint regardless (due to the cortisone) you have no idea whether or not the prescribed treatment is helping to alleviate their pain. Again, you might just be messing the particular joint up even more.

Not to mention there seems to be a good amount of evidence suggesting taking the shot will actually increase your chances of weakening, and possibly rupturing, the injected tendon. One example: http://ebm.bmj.com/content/16/4/116.full

Back to tendinosis, during tendinosis a tendon is chronically degraded, which means it has likely already become weak due to there being less of it…why would you want to inject a substance with evidence for weakening tendons into an already weak tendon???

How this rant was inspired: A few days ago a client came in for a training session and it had been about a week since I had seen her. She has arthritis in various joints throughout her body that typically feel decent. Namely her right knee acts up sporadically.

Anyways, she tells me she felt some knee pain while playing racquetball and subsequently experienced a good amount of swelling the next day or so. So she goes into see her doctor, her primary care doctor mind you (who probably specializes in cardiology), gets an x-ray, is diagnosed with “some arthritis” and is told she should come back in a few days to get a cortisone injection.

SOMEBODY KILL ME!!!!!  WHAT THE HELL KIND OF TREATMENT IS THIS?!?!?!

No wonder “chronic pain has no solution” when crap like this somehow qualifies as helping someone in pain.

For the love of god at least refer her out to an orthopedist or physical therapist, somebody who actually sees this type of thing everyday, and someone who can perform some testing or order an MRI to see if she tore anything, as she did get hurt while playing a sport involving a lot of cutting and twisting at the knee.

Seriously, if your doctor starts prescribing cortisone shots for a chronic condition you are on the path to a joint replacement. Your doctor is only going to be able to prescribe 3-4 shots per year for you and eventually they are going to wear off. Or the pain is just going to exceed what the shot does for you. Either way, you’re screwed.

Figure out what’s causing the chronic pain to begin with and go from there. No more band-aids!

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Posted in: Pain