This information sheet is intended for patients receiving a cortisone injection as part of their procedure at Melbourne Radiology Clinic
Melbourne Radiology Clinic - Cortisone Patient Information Sheet & Consent Form
What is cortisone?
Cortisone is a well known medication that is a very powerful anti-inflammatory. It is a substance produced naturally in our bodies every day in the small glands above each kidney known as the adrenal glands. The adrenal glands, which produced many substances, such as adrenalin and hormones, use cholesterol in the body to produce cortisone. Apart from having a powerful anti-inflammatory effect, cortisone also regulates immune function and is produced in greater amounts during times of stress.
Why use cortisone?
Cortisone is used to treat common painful ailments when other treatments, such as anti-inflammatory tablets (commonly known as non-steroidal anti-inflammatory medications-NSAIDs) have failed. By delivering a high dose into the affected body part, the powerful anti-inflammatory effects of cortisone may help treat a patient’s pain.
Cortisone is therefore used to treat common musculoskeletal complaints such as:
- bursitis
- Morton's neuroma
- tenosynovitis
- plantar fasciitis
- carpal tunnel syndrome
- arthritis
- adhesive capsulitis ("frozen shoulder").
How is cortisone administered?
In order to achieve a high dose in the area of interest, cortisone is usually given by injection. This is often done using imaging guidance (such as a CT scanner, or ultrasound machine) to ensure that the medicine is delivered in precisely the correct location and therefore offer the best chance of cure.
Why not take cortisone tablets?
Taking cortisone tablets is an option. In fact, many people take cortisone tablets for conditions where there are multiple sites of inflammation in the body, such as arthritis and where obviously injecting every painful site is likely to result in major discomfort. Cortisone tablets however are given at a much higher dose than what is injected, as the medication needs to travel throughout the entire body to suppress the inflammation. This then increases the chances of developing side effects, which can be serious. If however the pain experienced by a patient is localised to a single area or region, then an injection is preferred and therefore most of the side effects are avoided.
What are the side effects of cortisone?
There are many different side effects that have been described, however they do not occur all at once, nor in the same person. Most serious side effects of cortisone occur when taking cortisone tablets and for many months to years. These side effects include:
- Weight gain
- Osteoporosis
- Diabetes
- Fragile Skin & soft tissues
- Easy bleeding
- Depressed or elevated mood
- High blood pressure (hypertension)
The above side effects are avoided with a cortisone injection, as only a small dose is given that slowly is absorbed into the circulation over a period of many days to months.
There are, however,other side effects with cortisone injections:
- Pain flare – this is uncommon, however a well known side effect. The cortisone occasionally may make the pain in the region injected worse. This usually occurs within the first 24 hours following injection. The pain is often intense and worse than the pain for which the patient originally required the injection. Reassuringly, the pain disappears within 24 hours following onset and this can be hastened by taking over the counter anti-inflammatory medications (such as Voltaren) and paracetamol. Occasionally, paracetamol with codeine (such as panadeine, or panadeine forte) is required. If panadeine forte is necessary, you will require a prescription from our doctor. Please call Melbourne Radiology Clinic to have this arranged so that we may fax it to your nearest pharmacy for your convenience.
- Elevated blood sugar – this is an issue with diabetic patients. Allow for approximately three days of raised blood sugar levels, however this can continue for a week. If you monitor your blood sugar on a daily basis, your levels may even exceed 20. We prefer that diabetic patients err on the side of caution and ask that these patients are not too aggressive in trying to reduce your blood sugar levels with medication or insulin injections. This will avoid the risk of rapidly lowering sugar levels when the cortisone wears off; this is known as a “hypo”. Instead, carefully reduce your sugar intake and start some regular exercise.
- Facial flushing & palpitations – though annoying (and sometimes resulting in anxiety), no specific treatment is required. This side effect is more common in women and may commence soon after the injection and may last for several days.
- Skin pigment changes – this is an issue with people with dark skin. It is not harmful and no treatment is required, however some people may find this a cosmetic issue. It commonly occurs in injections of the hand.
- Loss of fatty tissues – this is an issue in the setting of multiple injections and particularly in heel injections, where patients often are injected for plantar fasciitis (“heel spurs”). The cortisone may result in breakdown of the normal fat pad overlying the heel (fat “atrophy”) which may result in long term pain with walking due to the decreased cushioning effect with less fat in this area. This side effect is often permanent.
- Weakened tissue and tendon rupture – cortisone injections are well known for their soft tissue weakening effect. Many injections into a tendon that is painful may place this tendon at risk of rupture, however, tendons which are sore and require an injection are already at an increased risk of rupture. For this reason, cortisone is injected around the tendon and not into the tendon, thereby soothing surrounding painful and often inflamed soft tissues, which may be the source of most of the pain. Cortisone may also weaken cartilage (the lining of joints) which may place a patient at risk of developing arthritis. For this reason, cortisone injections into joints are used sparingly and after careful consideration of your medical condition.
- Infection – this is not a side effect of cortisone, however a possible complication of any injection. Since injection is the means by which cortisone is often delivered into the body, there is a chance that an infection may occur anywhere where the skin surface has been breached. Sterilising the skin and using clean and sterile equipment decreases the risk of an infection, however does not completely eliminate this risk. An infection may occur along the path of the needle track, from the skin surface to the deepest point reached by the needle. Usually an infection results in pain occurring some two to three days following an infection and becomes progressively worse. This delayed presentation of pain distinguishes pain due to an infection from pain due to a post injection pain flare (which occurs within 24 hours). The infected area is reddened and patients may have symptoms such as a fever or simply be unwell. If this is the case, the doctor at Melbourne Radiology Clinic will prescribe antibiotics and recommend a scan to exclude a collection of pus in the deep soft tissues, known as an abscess. Though serious, and infection is a very rare event, occurring in easily less than 0.1% of patients
How many cortisone injections are permitted?
There is no scientifically proven limit for cortisone injections, however as a general rule, three injections into the same body part are permitted over a twelve month period. Injections more frequent than this are felt to place the injected tissue at risk of softening/weakening, which may be an issue in a joint for example, as this may accelerate arthritis. Also, if you have failed to respond to a series of three injections, then it is probably time your condition was reassessed to find out if the diagnosis correct. Has your condition worsened and are other forms of treatment, such as surgery, more appropriate?
If you do require more than three injections in a year, then the risk of the injection must be carefully balanced against the benefits of pain relief. Your referring doctor or the doctor at Melbourne Radiology Clinic will be happy to discuss your condition and address any concerns that you may have.
For more information contact Melbourne Radiology Clinic on (03) 9667 1667.
