1. What is Corticosteroid/Cortisone?
“Cortisone” is a popular term used for the group of drugs called corticosteroids. There are many types of corticosteroids, and at our clinic we commonly use the following:
a) Dexamethasone, Brand Name: Decadron
b) Triamcinolone Acetonide, Brand Name: Kenalog
c) Triamcinolone Hexacetonide, Brand Name: Aristospan
d) Methylprednisolone, Brand Name: Depo-Medrol
e) Betamethasone Sodium Phosphate and Acetate, Brand Name: Celestone Soluspan
2. Is Cortisone a steroid (corticosteroid)?
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates (humans). Two main classes of corticosteroids, Glucocorticoids and Mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behaviour.
Cortisone is a type of ‘corticosteroid’, however it is not anabolic, but rather functions as an anti-inflammatory.
3. What is Cortisone used for?
Corticosteroids are commonly used to reduce inflammation, which is associated with pain, swelling, and loss of function in the joints, tendons, muscles, and fascia. These include problems such as arthritis, synovitis, tendonitis, bursitis, fasciitis etc. The corticosteroid injection is generally used as an adjunct to a multifactorial treatment plan.
4. How is the treatment administered?
The patient gives consent for the procedure. The skin is prepared with an antiseptic and numbing spray. Sometimes the injection is performed by ultrasound guidance to enhance accuracy and improve outcomes. The injection uses a strict sterile technique. The corticosteroid is mixed with a local anaesthetic to minimize pain. The pain experienced during the injection is minimal in most cases and the patient can leave the clinic.
5. What are the benefits of Corticosteroids?
The injection can have both diagnostic and therapeutic benefits. If symptoms are reduced by the effect of the local anaesthetic, this provides clinical evidence that the structure injected is the partly a source of the pain, hence being ‘diagnostic’. Depending on the balance between mechanical and inflammatory components of the presenting problem, the injection may then provide a ‘therapeutic’ effect by reducing inflammation. The success of this depends on many factors including the duration of pain, severity of the problem, associated mechanical components and biological factors. For a small amount of patients there is no benefit at all. Appropriately administered, cortisone can greatly assist in definitively treating many conditions, as well as assisting with rehabilitation and an active lifestyle.
6. What are the risks and side effects?
As with any drug treatment there are some risks and side effects, however it is rare that there are any major complications with corticosteroid injections. A temporary increase in pain, known as a ‘post-steroid flare’ happens in less than 5% of patients and generally lasts for less than 48 hours after the injection. Tylenol/Advil and cold packs can help ease this pain. If it remains for more than 48 hours, please contact our office. There is a risk of weakening soft tissues, and it is recommended an injection around a tendon (or vital structures) is ultrasound guided and post injection the body part is rested for a week before a graded return to activity is allowed. There is a 1:20,000 chance of infection, and strict sterile technique is mandatory. Corticosteroid can temporarily raise blood sugar levels for a few days and for patients with diabetes this requires careful monitoring and management. Corticosteroids can discolour (blanch) the skin and/or cause a small amount of fatty necrosis. Corticosteroid injections are not likely to cause osteoporosis or avascular necrosis (AVN), which are side effects if steroids are taken orally for a prolonged period of time (eg. Prednisone). Corticosteroids should not be administered at sites of infection or post-surgical wounds that are still healing, as it may increase infection and/or increase length of healing.
7. How well do corticosteroids work
Corticosteroid injections for can provide patients with 2 to 3 months of pain reduction. Some people get long-term relief of 6 months or more with a single corticosteroid injection. If you have a moderate amount of inflammation, your chances of responding are likely better.
8. Advice for women
If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor approves them. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and other natural health products. Make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to book and attend all appointments, and call your doctor if you are having problems. We usually recommend follow-up appointments every 3 to 4 months.