Cortisone Shots: Damaging and Ineffective
When someone goes to a medical doctor with pain, often the first solution the doctor offers is a cortisone shot. While this can sometimes offer temporary relief, by reducing inflammation in the area, the shot does not address the cause of the problem and the pain usually comes back.
Cortisone is a steroid that is made and released by the adrenal glands located on our kidneys. When we are under stress, our body releases cortisol into the bloodstream. Injectable cortisol is synthetic and used to treat inflammation through direct injection into the affected area. It is typically prescribed specifically for joint inflammation in the shoulders, knees, hips, spine and wrists. While cortisone shots will sometimes reduce the inflammation in the injected area it is in fact it is dangerous, sometimes causing flare ups after injection and increasing the likelihood of tendon rupture. Cortisone injections can also cause nerve damage, and most commonly loss of calcium and cartilage. Finally, it delays the body’s natural repair response time and does nothing to address what has caused the pain in the first place.
Inflammation is the body’s way of telling you that there is is a problem in your body, and when you inject cortisone you are merely treating a symptom rather than the problem at hand. This means that your inflammation will keep coming back until the cause of the problem is solved. Additionally, if you have an underlying infection, cortisone injections can suppress the body’s natural ability to fight the infection via inflammation and potentially worsen the infection.
Cortisone Causes Tissue Damage
The medical community has known for a long time that steroids harm tissues. There are more than 62,000 research papers that come up on a search of the U.S. National Library of Medicine on “corticosteroid side effects”. So why are steroids so bad for tissue? All bones, tendons, muscles, and cartilage have stem cells living inside of them. These are there to help replenish cells that die off due to normal wear and tear. However, studies have shown that steroids at hurt these cells, leaving the tissue without any ability to repair or maintain itself for many months.
A newer study focused on the effects of steroids on the tendons of patients undergoing rotator cuff surgery. The original goal of the study was to map the amount and density of blood vessels in different parts of the shoulder rotator cuff tendons. This is important because we know that rotator cuff tears don’t heal well when the tendon has poor blood supply. While the study showed a pattern of blood vessels that might be helpful to surgeons, the biggest startling finding was that patients who had shoulder steroid shots before the surgery had 1/3 fewer blood vessels than the patients who didn’t get the shots.
In addition, cortisone crystallizes when it is injected, and those crystals can cause flare ups called a “cortisone flare.” Tendons can be weakened by corticosteroid injections that are administered near tendons due to the crystallization of the cortisone. Tendons take an extremely long time to heal once damaged, so injecting cortisone near a tendon is very risky.
Nerve damage can result from needle trauma, infection from an injection, or from bleeding.
Loss of Calcium and Cartilage
Frequent cortisone shots can result in bone demineralization, also known as osteopenia or osteoporosis. They can also lead to loss of cartilage. Among patients with knee osteoarthritis, an injection of a corticosteroid every three months over two years resulted in significantly greater cartilage volume loss and no significant difference in knee pain compared to patients who received a placebo injection, according to a study published by JAMA in May of this year. The steroid group also had a higher arthritis index, a score measuring the stages of joint disease, than the saline group. No difference was found in the amount of pain reported by either group. Researchers said the results suggest that while steroid injections, in theory, reduce inflammation, other purported benefits were not observed.
Cortisone Shots Delay the Body’s Natural Repair Response Time
Overall, people who receive cortisone shots have a lower rate of full recovery than those who did nothing or who underwent physical therapy, according to a major review article from the Lancet published in 2010. The study also showed that those who received a cortisone shot had a higher risk of relapse than those who decided to just wait out the pain and see what happened. To make matters worse, repeated shots tend to increase the likelihood for continued damage. This is the reason many physicians limit the number of cortisone shots a patient can receive to three a year. Unfortunately, even that amount can cause damage to the joint.
Diabetes and Cortisone
Cortisone can make diabetes worse. When released by the body, cortisone regulates blood sugar. When it’s injected, it causes more sugar to be released from the liver and blocks insulin for days following an injection.
While cortisone is a steroid that is naturally produced by the body, it is not necessarily safe when injected and can in fact be very harmful to the body in the long run. There are other ways of reducing inflammation, such as icing, rest, and working with your chiropractor to understand and treat the underlying cause of the problem.
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