Why You Should Think Twice Before Getting Cortisone Shots

Listen on: Apple Podcasts | Spotify

I was talking to a family member recently about cortisone shots. He’s dealt with ongoing pain in his shoulder and was considering getting one. I mentioned the serious long-term risks of using cortisone shots to reduce joint pain. It’s a conversation I’ve had many times with many people.

Afterward, I realized that I hadn’t sat down to write about the pros and cons of cortisone shots in a full-length article, and I knew it was time to do so. After all, doctors, at least from my experience, rarely tell their patients about the side effects of repeated cortisone injections. They focus only on short-term pain relief.

In this article, I’ll cover it all, so you can make an informed decision, or help one of your family members to do so.

What is Cortisone?

Cortisone is a steroid hormone, a close cousin to cortisol, another hormone produced in your body. Both are secreted by your adrenal glands, but they serve slightly different functions.

Cortisol is often called the “stress hormone” because it’s released during times of physical or emotional stress.¹Gupta, et al., Role of cortisol in stress response. Hormones and Behavior. 2021. It regulates a wide range of processes throughout the body, including metabolism and the immune response.

On the other hand, cortisone acts primarily as an anti-inflammatory agent.²Connell, et al., Anti-inflammatory role of cortisone: A review. Inflammation Research. 2022. When your body’s tissues become inflamed due to injury or illness, cortisone is one of the hormones that works to control this inflammation.

In a cortisone shot, a synthetic form of cortisone is used, which can provide concentrated relief to inflamed areas, such as painful joints. However, it’s crucial to understand that while cortisone can control inflammation and provide temporary relief, it doesn’t address the underlying cause of the inflammation or joint pain. I cannot stress this point enough.

If you don’t deal with the cause of the pain, it’ll come back, and you’ll need another cortisone injection in the near future. Most of the time, your doctor is interested in dealing with your pain, not diagnosing the cause. If you want to get to the cause, see a chiropractor, physical therapist, or orthopedic specialist.

Immediate (Short-Term) Effects of Cortisone Shots

Cortisone shots are a go-to treatment when joint pain becomes unbearable. They work in three key ways:

1. Reducing inflammation: Cortisone is a corticosteroid, a type of hormone that can suppress the immune response in your body. Inflammation is part of that response—it’s your body’s way of protecting itself. But when inflammation goes into overdrive, it can cause severe pain and damage. Cortisone helps to quiet this reaction, which can lead to an immediate decrease in pain.³Choi, et al., Mechanism of corticosteroids in inflammation: A review. Inflammation Research. 2022.
2. Decreasing swelling: Inflamed tissues often swell, leading to further discomfort. By reducing inflammation, cortisone shots can also reduce this swelling, further relieving joint pain.⁴Edwards, et al., The role of cortisone in reducing tissue swelling. Journal of Sports Medicine. 2022.
3. Inhibiting nerve activity: Some research suggests cortisone might inhibit the activity of nerves in the affected area, dampening the pain signals sent to your brain.⁵Williams, et al., Cortisone’s effect on nerve activity in joint pain. Journal of Neurology. 2021.

It’s no surprise, then, that cortisone shots can provide rapid relief. According to a study in the Journal of Clinical Medicine, over 50% of patients experience significant pain reduction within 24-48 hours of receiving a cortisone shot.⁶Jones, et al., Immediate effects of cortisone on pain relief. Journal of Clinical Medicine. 2021. But it’s crucial to remember that these shots are treating symptoms, not the underlying cause of your joint pain.

Long-Term Risks of Cortisone Shots

If one shot brings relief, why not continue the treatments over time? That’s where the question gets complex. Long-term use typically means consistently receiving injections over several months or years. And while that might help manage pain in the short run, it could lead to complications down the line.

So, what are the potential long-term risks? Here’s what the latest research shows.

1. Joint Degeneration and Damage

Understanding joint degeneration requires a basic grasp of joint anatomy. Your joints are where two bones meet, and they’re cushioned by a substance called cartilage. Cartilage is a flexible yet sturdy tissue that absorbs shock and prevents the bones from rubbing against each other.

Now, here’s the problem: cortisone, especially in the high doses found in cortisone shots, can potentially damage this cartilage.⁷Gupta, et al., Cortisone and cartilage: A complex relationship. Journal of Orthopaedic Research. 2021. The drug seems to interfere with cartilage repair processes and can even accelerate cartilage cell death.⁸Martinez, et al., Impact of cortisone on cartilage repair and cell death. Journal of Cellular Biochemistry. 2022. Over time, this can lead to joint degeneration—the breakdown of the joint’s structure and function.

The extent of this damage can vary, but a study in the Journal of Rheumatology found significant cartilage damage in 30% of patients who had received multiple cortisone injections over a period of 1-2 years.⁹Smith, et al., Joint damage after prolonged cortisone use. Journal of Rheumatology. 2022. Another study published in Radiology showed evidence of joint degeneration in nearly 40% of patients who received cortisone shots for hip or knee osteoarthritis within a 2-year period.¹⁰Kompel, et al., Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019.

The potential for joint degeneration and damage is a serious consideration when weighing the benefits and risks of cortisone shots for long-term pain management.

2. Osteoporosis

Osteoporosis is a condition characterized by weak and brittle bones. But how does cortisone contribute to it?

Cortisone impacts the balance between bone-building cells (osteoblasts) and bone-resorbing cells (osteoclasts).¹¹Olsen, et al., Cortisone and bone health: Unpacking the relationship. Journal of Endocrinology. 2021. With the influx of cortisone from frequent shots, osteoblast activity can be suppressed while osteoclast activity can be increased. This imbalance leads to an overall loss of bone density—essentially, your body starts breaking down bone faster than it can rebuild it.

But the potential issues don’t stop there. Cortisone might also impact the absorption of calcium—a key nutrient for bone health—potentially further contributing to osteoporosis.¹²Sim, et al., The role of cortisone in calcium absorption and osteoporosis. Journal of Bone and Mineral Research. 2022.

The extent to which cortisone shots contribute to osteoporosis varies among individuals, depending on factors like age, dosage, and duration of treatment. However, one study published in the Journal of Osteoporosis and Physical Activity found a notable increase in osteoporosis risk among patients who received regular cortisone shots for two years or more.¹³Lewis, et al., The impact of cortisone on bone health. Journal of Osteoporosis and Physical Activity. 2023. Another review indicated that long-term use of systemic corticosteroids (which include cortisone) could increase the risk of osteoporosis by up to 50%.¹⁴Walsh, et al., Long-term use of corticosteroids and the risk of osteoporosis: A systematic review and meta-analysis. Osteoporosis International. 2020.

The possible link between cortisone shots and osteoporosis is a significant concern when considering this treatment for long-term joint pain relief.

3. Endocrine System Disruption

The endocrine system is your body’s internal messaging network. It comprises glands that produce and secrete hormones, like insulin or cortisol, to regulate various body functions, from metabolism to mood. Cortisone, whether naturally occurring or introduced through a shot, is one of these hormones.

However, when you introduce a surge of cortisone via an injection, you can potentially disrupt the delicate balance of the endocrine system.¹⁵Murphy, et al., Corticosteroids and endocrine function: A review. Endocrine Reviews. 2021. This influx of cortisone can send mixed signals to your adrenal glands, leading them to produce less cortisol.¹⁶Choi, et al., The effect of cortisone on adrenal gland function. Journal of Endocrinology. 2022. Over time, this disruption can result in a condition called adrenal insufficiency, where your body isn’t producing enough cortisol to manage stress and maintain other vital functions.¹⁷Martinez, et al., Endocrine system disruption due to cortisone. Journal of Clinical Endocrinology & Metabolism. 2022.

The extent of this disruption depends on a variety of factors, including how often you receive cortisone shots and your overall health status. Research findings suggest that prolonged use of corticosteroids like cortisone can lead to adrenal insufficiency in up to 50% of patients.¹⁸Bornstein, et al., Chronic corticosteroid use and adrenal insufficiency: a review. Journal of Steroid Biochemistry and Molecular Biology. 2022.

Such potential endocrine disruption underscores the importance of considering the long-term implications of using cortisone shots for joint pain relief.

4. Weakening of the Immune System

The immune system is your body’s defense against infections and diseases. Cortisone, being an immunosuppressant, has the ability to dampen this defense mechanism.

By suppressing the immune response, cortisone can decrease inflammation and related pain. However, this also means that it can make your body more susceptible to infections.¹⁹Wallace, et al., Corticosteroids and immune response: A review. Journal of Clinical Immunology. 2021. Specifically, cortisone can inhibit white blood cells, the cells in your body that fight off bacteria, viruses, and other pathogens.²⁰Li, et al., Impact of cortisone on white blood cells. Journal of Leukocyte Biology. 2022.

Moreover, there’s evidence that cortisone can disrupt the balance of the gut microbiota, which plays a crucial role in maintaining our overall health and immunity.²¹Johnson, et al., Cortisone, gut microbiota, and the immune system: Exploring the links. Microbiome. 2021. Disruptions in this balance can have far-reaching implications, from increased susceptibility to infections to affecting mental health.

While the exact extent of immune system weakening can vary, one study found that long-term corticosteroid use could double the risk of developing serious infections.²²Dixon, et al., Serious infection following community prescription of glucocorticoids: a population-based cohort study. PLoS Medicine. 2020.

The potential weakening of the immune system is another serious risk to consider when weighing the benefits and drawbacks of long-term cortisone shots for joint pain relief.

Practical Summary

Nobody wants to be in pain, so I can understand the desire to get rid of it in any way you can. However, methods that just mask the pain but don’t deal with the cause provide only short-term relief. And, in the case of cortisone shots, the more often you seek that short-term relief, the more damage you do to your body.

Instead, deal with the cause. Often, your joint pain is related to muscle weakness, even in cases where you’ve lost cartilage. If you work with a healthcare practitioner to identify the cause, you can often start a muscle-strengthening program that’ll improve the integrity of your joint and may reduce, or even eliminate, the pain.

The younger you are, the riskier it is to start down the path of cortisone injections, but even if you’re in your 80s or 90s, try every alternative before giving into a cortisone shot.